What to Say and When? Prioritizing and Prompting Preventive Care Services

Karen G O'Connor ¹, Paula Duncan, MD ² and Joseph F Hagan Jr, MD ². ¹ Division of Health Services Research, American Academy of Pediatrics, Elk Grove Village, IL, United States, 60007 and ² Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT, United States, 05401.

 

BAckground: Pediatricians are expected to address an increasing number of topics during patient preventive care visits. Little is known about the way in which pediatricians make choices about the content of these visits or the resources used to prompt these services.

 

Objective: To assess ways in which pediatricians currently determine the content and emphasis of preventive care visits and to compare methods used to prompt preventive care services in 2003 with those used in 1992.

 

Design/Methods: National random sample, mailed survey in 2003 (56% response rate, n=538) and 1992 (80% response rate, n=788). Participants included US members of the American Academy of Pediatrics (AAP) who provide preventive care. Bivariate analyses assessed differences between years in methods of prompting preventive care services.

 

Results: 2003 Data: Pediatricians say time limitations (85%) and difficulty prioritizing among topics to be addressed in patient visits (53%) are barriers to implementing preventive care services. They report important factors in determining the focus of preventive care visits include continuing medical education (CME) (89%), residency training (82%), journal articles (81%), feedback from parents (80%) and written guidelines (76%). When asked specifically about AAP guidelines, 53% say the Guidelines for Health Supervision III is an important resource and 36% so named the Bright Futures guidelines and materials. 1992 and 2003 Comparisons: In both years >80% said they routinely use patient-held minirecords to track immunizations. In 2003 increases were reported in the use of flow sheets in patients? charts (69% v 75%, p<.05) and computerized tracking systems (16% v 21%, p<.01). Asked only in 2003, 2% report use of email reminders to parents and 46% report use of written assessments to prompt preventive services.

 

Conclusions: Many factors contribute to pediatricians? determination of the content and emphasis in preventive care visits. Types of resources used to assist pediatricians in prompting or tracking preventive services have changed somewhat over the last 10 years, although standard resources remain the primary methods. Increased use of written guidelines and other methods of prompting services may help to focus future preventive care visits.