Pediatricians, parents weigh in on well-child care

Focus groups identified expectations, areas for improvement.

Issue: November 2009

Low attendance rates for routine well-care visits, along with a higher prevalence of morbidities, including obesity, attention-deficit/hyperactivity disorder, depression and increasing adolescent risk behaviors, leave many in the pediatric community searching for answers to bridge disparities between traditional aspects of care and the unmet needs of patients today.

Existing approaches to well-child care are inadequate, according to Edward L. Schor, MD, vice president of the Commonwealth Fund, a New York City–based foundation formed to promote high-performing health care systems.

“Pediatricians cannot squeeze more into the limited time they have available for each well-child visit,” he wrote in a 2004 editorial published in Pediatrics. “The approach to preventive care, including the timing and content codified by the current periodicity schedule and the processes by which care is provided, needs to be changed.”

Researchers from several U.S. sites conducted two separate studies to assess parent and provider attitudes about well-child care. Tanner and colleagues conducted focus groups that involved more than 300 pediatric clinicians. Radecki and colleagues conducted 20 focus groups composed of 131 parents. The results of both studies were published recently in Pediatrics, and the studies concluded that many of the concerns among the two groups converged.

Sustaining a continuous patient–physician relationship, tailoring visits to meet individual patient needs with input from parents and dedicating more attention toward developmental and behavioral issues were three aspects that both groups felt were essential to the well-care visit.

“These areas of common interest may serve as building blocks to move forward the rethinking discussion in a way that is embraced by families and pediatricians,” Radecki and colleagues wrote.

Although both groups felt that developing a therapeutic relationship with individualized care is important, clinicians expressed difficulty addressing parents’ concerns while also covering the recommended-content outlined in professional guidelines.

Conversely, although developmental and behavioral issues are high on the agenda of both providers and parents, pediatricians said they felt as though coordination with community resources necessary to address problems in these areas is poor.

Ideas for remedying these problems were proposed among the focus groups in both studies and included the following:

Limit physical exams during the first 2 years of life to make more time for developmental–behavioral screening and counseling.
Use electronic medical records systems to generate previsit questionnaires that remind parents about upcoming visits and assist clinicians in addressing parents’ concerns; make previsit checklists for parents so they know what to expect during the visit.
Provide visit summaries to recap important information; organize parent workshops.
Conduct fewer but lengthier well-child visits; administer vaccines during a separate visit.
Reduce the time that occurs between arranging an appointment and the actual appointment.
Create national obesity and ADHD registries to compare treatment and promote improvement.
Create stronger curricula in developmental and behavioral pediatrics during residency.

Additional research into practical aspects of well-child care is needed and should include efforts to define the characteristics of a therapeutic relationship; compare different practice formats with outcomes; and evaluate the systems by which pediatric offices and community agencies are linked, according to Tanner et al.

For more information:

Radecki L. Pediatrics. 2009;124:858-865.

Schor EL. Pediatrics. 2004;114:210-216.

Tanner JL. Pediatrics. 2009;124:849-857.