PERIODIC SURVEY OF FELLOWS #56 - PEDIATRICIANS' PROVISION OF PREVENTIVE CARE AND USE OF HEALTH SUPERVISION GUIDELINES, 5/04

I. PROVISION OF PREVENTIVE CARE

Number and Length of Preventive Care Visits:

Pediatricians report an average of 50 preventive care visits/week: about 16 of these visits are with patients birth-11 months old, 12 are with children 1-4 yrs, 9 are with school age patients 5-10 yrs, about 6 visits per week are with adolescents 11-14 yrs, and about 6 are with adolescents older than 14 years.
The average length of time pediatricians say they personally spend with patients during a preventive care visit ranges from 17 minutes for infants, toddlers and school-aged patients to 19 minutes for younger adolescents and 20 minutes for older adolescents

Content of Preventive Care Visit

Nearly all pediatricians discuss nutrition/diet, physical growth, motor, language and cognitive development during health supervision visits with most (>75%) patients birth-4 years; about 70% discuss booster seats and sleep patterns, and 58% say they discuss oral health. Less than one-half report discussing any other behavioral or safety topic with >75% of their patients.
Eight out of 10 pediatricians say they discuss physical growth and nutrition with >75% of their patients 5-10 years of age; 6 out 10 discuss bike safety, oral health, physical exercise habits and use of booster seats/seat belts. Less than one-half discuss other behavioral or safety issues with >75% of their patients in this age group.
Eight out of 10 pediatricians discuss nutrition/diet and physical development with >75% of patients >11 years of age; 7 out of 10 discuss alcohol and drug use and physical exercise habits; about 60% discuss smoking, seat belts, STD/pregnancy prevention, and obesity prevention. About 50% discuss bike safety, oral health and school problems, while less than one-half discuss other psychosocial or safety issues with >75% of their patients in this age group.

Resources for Tracking and Educating Patients About Preventive Care:

About 80% of pediatricians report routinely using patient-held minirecords to track immunizations, 75% use summary lists in patient charts to prompt preventive services, 56% use telephone reminders to patients and 46% ask patients to complete written questionnaires at office visits. Fewer than 40% of pediatricians use any other type of reminder/prompting system.
88% of pediatricians routinely use pamphlets or other printed materials to educate patients about preventive services, 75% refer patients to community resources/programs, and 57% educate patients via counseling by nursing or office staff. Fewer than 30% use any other method of patient education.

Factors Determining the Content and Emphasis of Preventive Care Visits:

About 90% of pediatricians say information learned from CME is an important factor in determining the content and emphasis of a preventive care visit. Other important determinants named by pediatricians include written guidelines (85%), residency training (82%), journal articles (81%), and feedback from parents (80%); 73% say informal discussions with colleagues are important.
When asked specifically about the importance of the Bright Futures guidelines and the AAP Guidelines for Health Supervision III in determining the content and emphasis of preventive care visits, 53% of pediatricians say the AAP Guidelines is an important resource and 23% are unsure; 36% say Bright Futures guidelines/ materials are an important resource, however, a large proportion (38%) are unsure.

Barriers to Implementing Preventive Care Services:

Lack of time was named as a barrier to implementing recommended preventive care services by most pediatricians (85%). Other frequently named barriers include inadequate reimbursement for preventive care counseling (named by 58% of pediatricians), difficulty prioritizing among the preventive care topics (53%), patient/parent lack of interest in discussing some topics (47%) and unfamiliarity with CPT codes that reimburse for preventive care counseling (45%).

II. USE OF PREVENTIVE CARE GUIDELINES AND OTHER MATERIALS

Familiarity with and Use of Pocket Guides and Family Materials:

About 60% of pediatricians say they have never used the Bright Futures Guidelines for Health Supervision pocket guide and about 55% of pediatricians say they have never used the AAP Guidelines for Health Supervision III pocket cue cards, although most of these pediatricians are familiar with these resources.
Overall, most pediatricians (>60%) say they did not hand out any Bright Futures or AAP family materials to any parents during the 30 days prior to the survey, although most pediatricians (75%) say they are familiar with the AAP TIPP Safety Sheets and about half are familiar with the AAP Child Health Record, the One Minute Car Seat Safety Check-up and the adolescent brochure on smoking; fewer than 37% are familiar with any of the Bright Futures family materials.

Familiarity with and Use of Preventive Care Guidelines:

83% of pediatricians are very or somewhat familiar with the AAP Guidelines for Health Supervision III and 74% are very or somewhat familiar with Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents. About 44% of pediatricians are very or somewhat familiar with the Guidelines for Adolescent Preventive Services (GAPS); however, fewer than 40% are familiar with any other preventive care guideline. Among pediatricians who say they are at least vaguely familiar with (ie, have heard of) any of the Bright Futures guidelines or other materials (80% of pediatricians who provide preventive care), fewer than half (47%) say they use any of the Bright Futures guidelines/materials. Among these users:
	About 8 out of 10 say the guidelines are very or somewhat useful as a resource for preventive care counseling and as a source for developmental or psychosocial screening. Three-fourths say the developmental age/cycle sections within the guidelines are useful and that the pocket guides are a useful resource for preventive care counseling. About two-thirds of users say the guidelines are useful as a teaching tool with residents. About one-half of users say the family materials are useful as a source of patient education, and the guidelines are useful as a resource for diagnosis/treatment or community health advocacy.
	Nearly 90% of users agree Bright Futures guidelines serve as a reminder about health supervision topics; about 80% agree they are an excellent resource for nursing or other staff and the information within is accurate and up to date. Two-thirds say the content of the family materials is relevant and 60% say the reading level of family materials is appropriate.
Eight out of ten say they would be very or somewhat likely to use a separate Bright Futures guideline for children with special health care needs as a resource for preventive care counseling.

American Academy of Pediatrics, Division of Health Policy Research
Periodic Survey #56: Executive Summary
"Pediatricians' Provision of Preventive Care and Use of Health Supervision Guidelines", May 2004

Not for citation or quotation without permission of the author