Chuck Norlin|Morgan A. Crawford|Christopher T. Bell|Xiaoming Sheng|Martin T. Stein
Delivery of Well-Child Care: A Look Inside the Door
University of California, San Diego|University of Utah|University of California, San Diego|University of Utah|University of California, San Diego|University of Utah|University of California, San Diego|University of Utah|University of California, San Diego|University of Utah
describe delivery wellchild care components compare delivery recommendations bright futures compare delivery wellchild care children special health care needs children without special needsover 10week period 2 medical students observed documented characteristics wellchild care visits general pediatricians midlevel pediatric providers parents completed demographic questionnaire screener children special health care needsa total 483 visits 43 pediatricians 9 midlevel providers patients 0 19 years age observed adjusted mean visit duration 203 minutes 389 visits began openended question parentchild concerns mean 72 health supervisionanticipatory guidance topics addressed per visit clinicians addressed mean 42 bright futuresrecommended agespecific health supervisionanticipatory guidance topics topics addressed less frequently recommended included family support parental wellbeing behaviordiscipline physical activity media screen time risk reductionsubstance use pubertysex socialpeer interactions violence shorter visits associated asking parentchild concerns addressing greater proportions recommended health supervisionanticipatory guidance topics wellchild care visits children special health care needs 36 longer children without special needs addressed similar numbers agespecific health supervisionanticipatory guidance topics time spent children special health care needs addressing health supervisionanticipatory guidance topics conditions usually chronic condition testing prescriptions referralsutilizing direct observation visits pediatric clinicians found solicitation parentchild concerns occurred less frequently recommended fewer half recommended visitspecific health supervisionanticipatory guidance topics addressed little congruence bright futures age groupspecific recommendations notably solicitation patientparent concerns greater adherence health supervisionanticipatory guidance recommendations associated shorter visits wellchild care visits children special health care needs longer children without special needs time spent addressing similar numbers health supervisionanticipatory guidance topics well chronic conditions