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Duration and Direct Cost of Behavioral Health Concerns in Pediatric Primary Care (EI)

This study has been completed.
Information provided by (Responsible Party):
Rachel Valleley, PhD, University of Nebraska Identifier:
First received: June 15, 2009
Last updated: August 31, 2017
Last verified: August 2017
The purpose of this study is to compare the duration and direct cost of pediatric primary care visits consisting of medical concerns only, behavioral concerns only, and medical and behavioral concerns.

Mental Health

Study Type: Observational
Study Design: Observational Model: Case-Only
Time Perspective: Cross-Sectional
Official Title: Duration and Direct Cost of Behavioral Health Concerns in Pediatric Primary Care

Further study details as provided by Rachel Valleley, PhD, University of Nebraska:

Enrollment: 228
Study Start Date: April 2009
Study Completion Date: August 2010
Primary Completion Date: March 2010 (Final data collection date for primary outcome measure)
Detailed Description:

Behavioral, emotional, and psychosocial issues of children and adolescents are often brought to the attention of primary care physicians by parents (Smith, Rost, & Kashner, 1995). In fact, behavioral health concerns are the primary reason for visits to physicians in 15% to 21% of cases (Kelleher, Childs, Wasserman, McInerny, Nutting, & Gardner, 1997; Lavigne, Gibbons, Arend, Rosenbaum, Binns, & Christoffel, 1999; Williams, Klinepeter, Palmes, Pulley, & Foy, 2004). During 50% to 80% of child health care visits, parents or physicians raise concerns of behavioral or psychosocial issues (Cassidy & Jellinek 1998; Fries, Koop, Beadle, Cooper, England, Greaves, et al., 1993; Sharp, Pantell, Murphy, & Lewis, 1992).

Several concerns have been raised when patients seek mental health services from primary care physicians, including an increase in the number of medical visits, an increase in the time spent with the physician, lost revenue if a patient takes more time than scheduled, a lower reimbursement rate for mental health issues, limited training in mental health treatment, a decrease in the number of patients seen, an increase in the risk of physician burnout, unsatisfied patients, an increase in impairment in patient health and functioning, and an increase in the use of acute and emergency care (Connor, McLaughlin, Jeffers-Terry, O'Brien, Stille, Young, & Antonelli, 2006; deGruy, 1997; Leaf, Owens, Levelthal, Forsyth, Vaden-Kiernan, Epstein, et al., 2004; Strosahl, 2002; Young, Klap, Sherbourne, & Wells, 2001).

There are limited studies examining the time and cost incurred by physicians for treating patients with behavioral, emotional, and psychosocial issues. Average primary care visits last between 13 and 17 minutes (Blumenthal, Causino, Chang, Culpepper, Marder, Saglam, et al., 1999; Bryant & Shimizu, 1988) A more recent study conducted in rural communities found that physicians spent an average of 5 to 7 minutes longer on visits where behavioral issues were raised (Cooper, Valleley, Polaha, Begeny, & Evans, 2006). Primary care physicians see four or five patients per hour (deGruy, 1997), which is an insufficient amount of time for a detailed psychological assessment or management of mental health symptoms. Therefore, frequent or longer visits are scheduled. Additionally, physicians are reimbursed for medical diagnosis but not mental diagnoses (deGruy).

This study is based on previous work documenting that pediatric primary care visits increased in duration when behavioral concerns were identified prior to the visit and spontaneously raised during the visit (Cooper, et al., 2006). Additionally, this study calculates the reimbursement rate associated with those visits in addition to the duration of the visit. Finally, this study is a replication of a study previously approved through the University of Nebraska Medical Center Institutional Review Board (i.e., IRB # 449-07-EP).


Ages Eligible for Study:   Child, Adult, Senior
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population
Approximately 500 patients from a pediatricin office will be reviewed.

Inclusion Criteria:

  • Patients who attend a local pediatrician clinic between between March 2009 and March 2010

Exclusion Criteria:

  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT00922922

United States, Nebraska
Munroe Meyer Institute
Omaha, Nebraska, United States, 68198-7830
Sponsors and Collaborators
University of Nebraska
Principal Investigator: Rachel Valleley, Ph.D. Munroe Meyer Institute
  More Information

Responsible Party: Rachel Valleley, PhD, Associate Professor, University of Nebraska Identifier: NCT00922922     History of Changes
Other Study ID Numbers: 136-09-EP
Study First Received: June 15, 2009
Last Updated: August 31, 2017 processed this record on September 21, 2017