Perceived Quality of Care and Pediatricians' Moral Distress Caring for Children with Mental Health Conditions.
Academic Article
Overview
abstract
OBJECTIVE: This study describes general and subspecialty pediatricians' experience of moral distress in providing care to children with mental health conditions, variation in moral distress across subspecialties, and associations between perceived care quality, practice characteristics, and moral distress. METHODS: This study analyzed survey data collected during 2022 American Board of Pediatrics Maintenance of Certification enrollment. Questions included perceived frequency with which high quality care was provided to children with mental health conditions (with suboptimal care quality defined as the lowest 2 response options on a 5-point Likert scale) and 4 potential sources of moral distress; high moral distress was defined as a top quartile composite score. Multivariable logistic regression was used to estimate associations between perceived suboptimal care quality, practice characteristics, and high moral distress. RESULTS: 5363 eligible pediatricians (55.2%) participated in the survey, including 3254 (60.7%) general pediatricians and 2109 (39.3%) subspecialists. Overall, 1147 (22.7%) reported perceived suboptimal care quality. Composite moral distress scores were highest for emergency medicine (n=106, 45.9% in highest quartile), child abuse (n=9, 39.1% in highest quartile), and hospital medicine physicians (n=109,32.5% in highest quartile). In regression analysis, high moral distress was associated with perceived suboptimal care quality, female gender, subspecialty, rurality, public insurance in practice, and academic appointment. CONCLUSIONS: Approximately one-in-five pediatricians perceived suboptimal care quality for children with mental health conditions; this was associated with greater moral distress and several practice characteristics. Improving mental healthcare access, resources, and pediatricians' capacities to provide high quality care may benefit clinicians as well as children.
