Study of Well-Child Visits Analyzes Content and Satisfaction

September 19, 2011 — Although most well-child visits for children under 3 years of age are of "short duration," parent satisfaction is generally high, according to the results of a cross-sectional national survey in the October 2011 issue of Pediatrics (published onlineSeptember 19).

Among a subset of 1428 parents who participated in the 2000 National Survey of Early Childhood Health (NSECH), one third reported spending 10 minutes or less with the clinician during their well-child visit, 47% reported visits lasting 11 to 20 minutes, and 20% reported visits of 21 minutes or more, reported Neal Halfon, MD, from the Center for Healthier Children, Families and Communities at the University of California, Los Angeles, and colleagues.

"Longer visits are associated with more developmental screening, discussions of more psychosocial risks, and greater parent satisfaction," they write. However, "even with the shortest visits parent-reported satisfaction generally was high."

The NSECH included 2068 parents of children aged 4 to 35 months, of whom 1428 provided details about their well-child visit within the past year.

Participants were asked about the length of the visit, their satisfaction with the visit, and the content of care in terms of anticipatory guidance, psychosocial assessment of risks, developmental assessment, and family-centered care.

Regardless of the length of visit, more than 80% of parents reported receiving anticipatory guidance on immunizations and breastfeeding, with more issues such as sleeping position, feeding issues, and car seats being included in longer visits.

"The pattern indicated that traditional topics that have been part of anticipatory guidance for decades are most likely to be addressed, whereas topics added more recently are less likely to get mentioned when time is short," the authors write.

"Overall, many anticipatory guidance topics were provided more frequently than a developmental assessment (which ranged between 50% and 68% depending on the visit length)," they note.

Ninety-nine percent of parents reported having adequate time with their doctors when the visit was 21 minutes or longer, compared with 76% of parents whose visits lasted 10 minutes or less.

Parental satisfaction remained higher with longer visits even after adjustment for the content of the visit, supporting the notion that "a trusting relationship and good communication between parents and their child’s pediatrician is a key component of optimal well-child care," they suggest.

The authors note that demands on pediatricians performing well-child visits continue to expand as new directives clash with time constraints and lack of reimbursement.

"Efforts to improve preventive services will require strategies that address the time devoted to well-child care," they note.

A focus on parent-identified concerns, the integration of previsit questionnaires, tiered systems that allot more time to higher-risk children, and the division of some care with nonphysician clinicians are among suggested strategies that might enhance care, they write.

"Ultimately, greater reimbursement for preventive and developmental services may best encourage the devotion of time and attention to their provision," they conclude.

The study was supported by the Commonwealth Fund and the Gerber Foundation. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online September 19, 2011.