TY - JOUR
AU - T. T. Doan
AU - D. R. Wright
AU - M. DeJonckheere
AU - D. W. Hutton
AU - K. N. Ray
AU - L. A. Prosser
A1 - 
AB - IMPORTANCE: Universal adolescent depression screening is recommended as routine primary care, but it is unclear how best to implement it. Systematic evaluation of physician preferences can support optimal screening implementation. OBJECTIVE: To assess primary care physicians' preferences for different attributes of a universal adolescent depression screening strategy. DESIGN, SETTING, AND PARTICIPANTS: In this survey study, a discrete choice experiment was administered to a US physician panel maintained by Qualtrics. Five attributes were identified from prior qualitative work: screening modality, screening location, screening completion time, missed depression cases, and clinical examination time, each with 2 to 3 levels. The survey presented 13 discrete choice questions and physician characteristics' questions. The survey was pretested through cognitive debriefings, piloted to an independent sample, and fielded to the final sample from April to June 2024. MAIN OUTCOMES AND MEASURES: Physicians' preference and importance coefficients for different screening strategies using time to assess willingness to make trade-offs for changes in attribute levels were estimated. Data were analyzed using conditional logit and latent class models. RESULTS: Among the 181 physician respondents (96 males [53.0%]), 90 (49.7%) were in urban settings, 112 (61.9%) were in a pediatrics primary care specialty, and 68 (37.6%) were in private practice. Conditional logit analyses showed that respondents preferred the least missed depression cases (59.6% importance), shortest clinical examination time (21.0% importance), 3-minute screening time (12.9% importance), private area provision (3.8% importance), and electronic modality (2.7% importance). Physicians reported their willingness to spend 37.3 minutes (95% CI, 32.1-42.5 minutes) during examinations per patient to reduce missed diagnoses from 10% to 5%. In the latent class analysis, 3 subgroups were identified. The diagnostic accuracy-sensitive group (n = 66) prioritized the top important attribute, missed depression cases (75.1% importance), more than other groups. The clinic time-sensitive group (n = 33) prioritized shortening examination time (35.2% importance) more than other groups. The screener type-specific group (n = 82) prioritized 3-minute screening (25.8% importance) and electronic modality (10.2% importance) more than other groups. CONCLUSION AND RELEVANCE: In this survey study, primary care physicians preferred identifying adolescent depression accurately and shortening well-child examination time. Health systems and payers should consider these preferences for accuracy and efficiency by physicians, who are strongly positioned to identify adolescent depression early and to implement screenings. Further research is needed to better understand family and administrative staff preferences regarding pediatric integrated behavioral health care.
AD - Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora.; Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts.; Department of Family Medicine, University of Michigan Medical School, Ann Arbor.; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor.; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.; Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor.
AN - 41288976
BT - JAMA Netw Open
C5 - Healthcare Disparities; Education & Workforce
CP - 11
DA - Nov 3
DO - 10.1001/jamanetworkopen.2025.45361
DP - NLM
ET - 20251103
IS - 11
JF - JAMA Netw Open
LA - eng
N2 - IMPORTANCE: Universal adolescent depression screening is recommended as routine primary care, but it is unclear how best to implement it. Systematic evaluation of physician preferences can support optimal screening implementation. OBJECTIVE: To assess primary care physicians' preferences for different attributes of a universal adolescent depression screening strategy. DESIGN, SETTING, AND PARTICIPANTS: In this survey study, a discrete choice experiment was administered to a US physician panel maintained by Qualtrics. Five attributes were identified from prior qualitative work: screening modality, screening location, screening completion time, missed depression cases, and clinical examination time, each with 2 to 3 levels. The survey presented 13 discrete choice questions and physician characteristics' questions. The survey was pretested through cognitive debriefings, piloted to an independent sample, and fielded to the final sample from April to June 2024. MAIN OUTCOMES AND MEASURES: Physicians' preference and importance coefficients for different screening strategies using time to assess willingness to make trade-offs for changes in attribute levels were estimated. Data were analyzed using conditional logit and latent class models. RESULTS: Among the 181 physician respondents (96 males [53.0%]), 90 (49.7%) were in urban settings, 112 (61.9%) were in a pediatrics primary care specialty, and 68 (37.6%) were in private practice. Conditional logit analyses showed that respondents preferred the least missed depression cases (59.6% importance), shortest clinical examination time (21.0% importance), 3-minute screening time (12.9% importance), private area provision (3.8% importance), and electronic modality (2.7% importance). Physicians reported their willingness to spend 37.3 minutes (95% CI, 32.1-42.5 minutes) during examinations per patient to reduce missed diagnoses from 10% to 5%. In the latent class analysis, 3 subgroups were identified. The diagnostic accuracy-sensitive group (n = 66) prioritized the top important attribute, missed depression cases (75.1% importance), more than other groups. The clinic time-sensitive group (n = 33) prioritized shortening examination time (35.2% importance) more than other groups. The screener type-specific group (n = 82) prioritized 3-minute screening (25.8% importance) and electronic modality (10.2% importance) more than other groups. CONCLUSION AND RELEVANCE: In this survey study, primary care physicians preferred identifying adolescent depression accurately and shortening well-child examination time. Health systems and payers should consider these preferences for accuracy and efficiency by physicians, who are strongly positioned to identify adolescent depression early and to implement screenings. Further research is needed to better understand family and administrative staff preferences regarding pediatric integrated behavioral health care.
PY - 2025
SN - 2574-3805
SP - e2545361
ST - Physician Preferences for Universal Routine Depression Screening for Adolescents in Primary Care
T1 - Physician Preferences for Universal Routine Depression Screening for Adolescents in Primary Care
T2 - JAMA Netw Open
TI - Physician Preferences for Universal Routine Depression Screening for Adolescents in Primary Care
U1 - Healthcare Disparities; Education & Workforce
U3 - 10.1001/jamanetworkopen.2025.45361
VL - 8
VO - 2574-3805
Y1 - 2025
ER -