The history of managed care and the role of the child and adolescent psychiatrist

Patient-Centered Care: An Examination of Provider-Patient Communication Over Time

OBJECTIVE

To examine the quality of provider communication over time considering the increasing emphasis on patient-centered care (PCC). Patient-centered care has been shown to have a positive impact on health outcomes, care experiences, quality-of-life, as well as decreased costs. Given this emphasis, we expect that provider-patient communication has improved over time.

DATA SOURCE

We collected primary data by self-report surveys between summer 2017 and fall 2018.

STUDY DESIGN

We use a quantitative retrospective cohort study of a national sample of 353 patients who had an ostomy surgery.

DATA EXTRACTION METHOD

We measure provider communication from open-ended self-reports from patients of the number of stated inadequacies in their care.

PRINCIPAL FINDINGS

Results show that the time since patients had their surgery is related to higher quality provider communication. That is, patients who had their surgery further back in time reported higher quality provider communication compared with patients who had their surgery performed more recently.

CONCLUSION

Results suggest that the quality of provider communication has not improved even with an emphasis on PCC.

Psychotropic Medication Use among Insured Children with Autism Spectrum Disorder

This study examined psychotropic medication use among 7901 children aged 1-17 with autism spectrum disorder (ASD) in five health systems, comparing to matched cohorts with no ASD. Nearly half (48.5 %) of children with ASD received psychotropics in the year observed; the most common classes were stimulants, alpha-agonists, or atomoxetine (30.2 %), antipsychotics (20.5 %), and antidepressants (17.8 %). Psychotropic treatment was far more prevalent among children with ASD, as compared to children with no ASD (7.7 % overall), even within strata defined by the presence or absence of other psychiatric diagnoses. The widespread use of psychotropics we observed, particularly given weak evidence supporting the effectiveness of these medications for most children with ASD, highlights challenges in ASD treatment and the need for greater investment in its evaluation.