Reflections on Well-Child Care Practice: A National Study of Pediatric Clinicians

Division of Developmental and Behavioral Pediatrics, Children's Hospital & Research Center Oakland, Oakland, California, USA.
PEDIATRICS (Impact Factor: 5.47). 09/2009; 124(3):849-57. DOI: 10.1542/peds.2008-2351
Source: PubMed


To assess perspectives about the practice of well-child care among pediatric clinicians, especially in the areas of child development and behavior.
Thirty-one focus groups (282 pediatricians and 41 pediatric nurse practitioners) in 13 cities addressed current practices, priorities used to determine content of well-child care visits, and changes to improve visit quality and outcomes.
Although most clinicians were positive about their practice of well-child care, they reported areas of concern and suggested ideas for improvements. Establishing a therapeutic relationship and individualizing care were viewed as significant contributions to quality of care. Participants agreed about the importance of eliciting parent concerns as the first priority for all well-child care visits. Community resources outside the office setting were seen as both a major influence on and, in some communities, a limitation to pediatric care. The challenges of early recognition of developmental and behavior problems through standardized questionnaires and effective interviewing were viewed as a priority to improve pediatric effectiveness in monitoring and treatment. To enhance primary care practices in developmental and behavioral pediatrics, participants suggested innovations in practice organization, community linkages, information technology, and integration of existing innovative programs. Education for pediatricians and enhanced resident training in developmental and behavioral pediatrics were endorsed.
Pediatric clinicians' support a vision of preventive care that is comprehensive, family centered, and developmentally relevant, both for children with greater risk to long-term healthy development and for families with more normative child-rearing concerns.

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    • "The preventative care guidelines for general practice in Australia advocate the provision of parent education, including accident and injury prevention, nutrition advice and child health surveillance [7]. However, if this is done in a didactic way where the GP is ‘telling’ the family what to do, it is not likely to be successful [24]. This change from ‘passive recipient to active consumer’ can also result in the GP feeling that their role as a primary health care and information provider has diminished [25]. "
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    ABSTRACT: Background In a General Practitioner (GP) setting, preventative medicine is reported as the predominant source of health care for the well-child. However, the role of the GP in well-child health care is not well understood in Australia. The aim of this study was to describe the role of the GP in providing services for well-children and families in Australia. Methods This was a qualitative descriptive study. Face-to-face interviews were held with 23 GPs to identify their role in the provision of well-child health care. Participants worked in a variety of general practice settings and 21 of the 23 GPs worked in the Greater Western Sydney area. Results Five main themes were identified in the analysis: ‘prevention is better than cure’, ‘health promotion: the key messages’, ‘working with families’, ‘working with other health professionals’, and ‘barriers to the delivery of well-child health services’. Conclusions Participating GPs had a predominantly preventative focus, but in the main well-child care was opportunistic rather than proactive. The capacity to take a primary preventative approach to the health of children and families by GPs is limited by the increasing demands to manage chronic disease. Serious consideration should be given to developing collaborative models of care where GPs are joined up with services funded by State and Territory governments in Australia, such as the universal maternal child and family health nursing services that have well children and families as their prime focus.
    Full-text · Article · Jan 2013 · BMC Family Practice
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