Trends in Child and Adolescent Mental Health Care for Military Dependents in Preventive Care Family Medicine Visits: Direct Care Versus Purchased Care (2018-2022).
Nationwide trends from 2018 to 2022 demonstrated rising pediatric mental health diagnoses amidst a specialist shortage, shifting care to primary care settings. Specific trends among patients seen by family physicians in the military health system have not previously been published. This study addresses a research gap by characterizing mental, emotional, neurodevelopmental, and behavioral health (MEDB) care trends provided by family physicians to military dependent children in direct (military treatment facilities) and purchased (civilian) care systems, focusing on preventive visits.
A retrospective observational analysis was conducted examining preventive visits (N = 193,495) between 2018 and 2022. MEDB diagnoses were grouped into 16 categories based on ICD-10 codes. Descriptive statistics and joinpoint regression analyses assessed changes in diagnosis rates and trends by age group (5-11, 12-17, 18-25 years) and care system. Logistic regression and odds ratios looked at associations between MEDB diagnosis and care system, adjusting for age, sex, and year of diagnosis. Further analyses looked at associations between MEDB diagnosis and care system, adjusting for sex and year of diagnosis and stratified by age.
MEDB diagnoses during preventive visits significantly increased (P < .05) in both systems and all age groups between 2018 and 2022. Children aged 5-11 most commonly received neurodevelopmental diagnoses, while anxiety, depressive, and trauma/stress related disorders predominated among adolescents and young adults. The number of preventive visits with multiple MEDB diagnoses nearly doubled in purchased care (2018 N = 481; 2022 N = 936). In direct care, there was an average quarterly increase in MEDB diagnoses between 7.6% (5- to 11-year olds) and 10.9% (12- to 17-year olds); in purchased care the average quarterly increase was between 6.6% (5- to 11-year olds) and 14.7% (18- to 25-year olds) in MEDB diagnoses.
From 2018 to 2022, the percent of preventive visits associated with MEDB diagnoses managed by family physicians significantly increased. These findings emphasize the importance of enhancing behavioral health training and resources for family physicians to optimize military family well-being and support service member readiness.
A retrospective observational analysis was conducted examining preventive visits (N = 193,495) between 2018 and 2022. MEDB diagnoses were grouped into 16 categories based on ICD-10 codes. Descriptive statistics and joinpoint regression analyses assessed changes in diagnosis rates and trends by age group (5-11, 12-17, 18-25 years) and care system. Logistic regression and odds ratios looked at associations between MEDB diagnosis and care system, adjusting for age, sex, and year of diagnosis. Further analyses looked at associations between MEDB diagnosis and care system, adjusting for sex and year of diagnosis and stratified by age.
MEDB diagnoses during preventive visits significantly increased (P < .05) in both systems and all age groups between 2018 and 2022. Children aged 5-11 most commonly received neurodevelopmental diagnoses, while anxiety, depressive, and trauma/stress related disorders predominated among adolescents and young adults. The number of preventive visits with multiple MEDB diagnoses nearly doubled in purchased care (2018 N = 481; 2022 N = 936). In direct care, there was an average quarterly increase in MEDB diagnoses between 7.6% (5- to 11-year olds) and 10.9% (12- to 17-year olds); in purchased care the average quarterly increase was between 6.6% (5- to 11-year olds) and 14.7% (18- to 25-year olds) in MEDB diagnoses.
From 2018 to 2022, the percent of preventive visits associated with MEDB diagnoses managed by family physicians significantly increased. These findings emphasize the importance of enhancing behavioral health training and resources for family physicians to optimize military family well-being and support service member readiness.
Authors
Williams Williams, Kim Kim, Sharma Sharma, Cafferty Cafferty, Hisle-Gorman Hisle-Gorman, Crawford Crawford, Goodie Goodie
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