Well-Child Visits Suffer From Time Squeeze: Study
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Longer well-child visits for babies and toddlers make for happier parents because doctors can fit in more advice and answer more questions, a new study finds.
But most well-child visits last less than 20 minutes and pediatricians are getting even more time-crunched as health care systems look to cut extra expenses any way they can, researchers write in Pediatrics.
“The disability rates for children continue to increase, and the nature of disability is changing,” with more kids getting diagnosed with behavioral and developmental problems, lead author Dr. Neal Halfon, from the University of California, Los Angeles Center for Healthier Children, Families and Communities, told Reuters Health.
“You have to wonder whether the front line of interaction with children and families is adapting and adopting changes in how they’re doing business so they’re addressing those issues and concerns of parents,” he said.
In 2000, the researchers conducted a phone survey of about 1,700 parents across the U.S. with a child between four months and three years old. They asked parents how much time they had spent with a doctor at their last well-child visit and whether the doctor had talked with them about issues such as breastfeeding, the child’s sleeping position and sources of family support.
Parents also reported how satisfied they had been with the visit.
About one-third of parents said their most recent appointment lasted 10 minutes or less. Only one in five had a visit lasting more than 20 minutes.
During longer visits, doctors gave a more thorough developmental assessment and discussed more health and safety issues with parents, and more parents said they’d had enough time to ask questions. Still, parents said they didn’t get any guidance about issues including child care, toilet training and emotional support at more than half of the longest visits.
The researchers cautioned that all information about visits was based on parents’ recollections, so bias could have crept in. And it’s not clear whether shorter appointments led to any more health problems down the road.
In general, parents reported being very satisfied with their appointments - but were the most satisfied when doctors spent more than 20 minutes with the family.
Researchers said that regular appointments early in life can help prevent disease and injury and make sure youngsters aren’t falling behind on social or learning skills.
“The well-child visit is a key in assuring healthy growth and development for children in the United States,” said Dr. Eugene Dinkevich, a pediatrician from the State University of New York Downstate Medical Center in Brooklyn.
But, “There is a lot pressure on physicians… not to do it as well as they could.” That’s because financial pressures—including low reimbursement rates from government-run insurance programs—mean they have less time to spend with each patient, added Dinkevich, who didn’t participate in the new study.
Addressing that problem head-on will take system-wide changes, he said. But Dinkevich and Halfon agreed that in the short term, pediatricians can take steps to make sure families are getting the best possible guidance.
For example, they can figure out which families will benefit most from certain types of counseling and education to customize visits to fit their needs, Halfon suggested. All parents might not want a “Marcus Welby moment,” he added.
In addition, most parts of the well-child visit besides the actual physical exam can be done with small groups of families together in one room, researchers said.
“The goal is to have better communication (and) more appropriate interaction,” Halfon concluded.
SOURCE: Pediatrics, online September 19, 2011.
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Duration of a Well-Child Visit: Association With Content, Family-Centeredness, and Satisfaction
Conclusions: Many well-child visits are of short duration, and shorter visits are associated with reductions in content and quality of care and parent satisfaction with care. Efforts to improve preventive services will require strategies that address the time devoted to well-child care. The results of this study should be interpreted in light of changes in practice standards, reimbursement, and outcome measurement that have taken place since 2000 and the limitations of the measurement of utilization solely on the basis of parent report.
# Neal Halfon, MD, MPH,
# Gregory D. Stevens, PhD,
# Kandyce Larson, PhD,
# Lynn M. Olson, PhD
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