PARENT-PROVIDER AGREEMENT ON ANTICIPATORY GUIDANCE DELIVERED: WHAT IS REMEMBERED AFTER THE VISIT?

Shari L Barkin¹, Benjamin Scheindlin², Edward H Ip³, Stacia A Finch⁴, Eric J Slora⁴ and Richard C Wasserman^4,5. ¹Pediatrics, Wake Forest University School of Medicine, Winston Salem, NC; ²Burlington Pediatrics, Burlington, MA; ³Public Health Sciences, Wake Forest University School of Medicine, Winston Salem, NC; ⁴Pediatric Research in Office Settings, Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, IL and ⁵Pediatrics, University of Vermont, Burlington, VT.

 

BACKGROUND:  Anticipatory guidance is at the cornerstone of primary care pediatrics, but limited studies examine recall of information after health supervision (HS) visits.

 

OBJECTIVE:  To examine agreement about topics discussed between parent and provider during the well child visit.

 

DESIGN/METHODS:  In a national randomized controlled trial currently underway in the Pediatric Research in Office Settings (PROS) network, 468 parents of patients ages 2-11 participated in an intervention group emphasizing (but not limited to) anticipatory guidance regarding: media use (eg, TV, computer, gameboy), discipline, and access to firearms/firearm storage. Immediately after the visit, parents and providers completed surveys to record what topics were discussed. Agreement percentages (parent and provider agreement that a topic had or had not been discussed) were calculated. As correcting agreement for chance using the Kappa statistic is unsuitable with an intervention in place, we do not report Kappa values.

 

RESULTS:  Respondents typically were married (75%), had some college or a college degree (61%), a family income of $80,000/year or more (32%), and had two or more children under the age of 12 (64%). Most providers (73%) were the regular care provider for the patient.

The table shows agreement percentages between parents and providers about specific topics discussed or not discussed (in parentheses) during HS visits.

Parent-Provider Concordance
Media Use	Discipline	Firearm access and storage	Bike Helmets	Drowning prevention	Home fights	Carseats/seat belts
90% (1%)	79% (2%)	73% (7%)	46% (38%)	19% (63%)	16% (58%)	50% (34%)

% agreed topic discussed (% agreed topic not discussed)

CONCLUSIONS:  Topics focused on in the intervention were discussed at a higher rate. Parents and providers have excellent agreement (74-91%) about topics discussed during HS visits.