Seconds for care: evaluation of five health supervision visit topics using a new method

Martin, L. A.; Ariza, A. J.; Thomson, J. S.; Binns, H. J.; Pediatric Practice Research, Group

J Pediatr. 2008 Jul 1; 153(5):706-11, 711 e1-2


OBJECTIVE: To describe content and time devoted to 5 preventive health topics during health supervision visits (HSVs). STUDY DESIGN: New software (Pediatric Health Supervision Timer Software, PHSTS) run in handheld computers was developed to record time and content while observing HSVs. 185 visits of children ages 2 to 10 years (58% Medicaid/self-pay) to 28 clinicians were observed at 6 practices. Parents were surveyed on demographics. Data on times and actions related to assessments and counseling of growth, diet, physical activity, safety, and tobacco were collected using PHSTS. RESULTS: The PHSTS method was well accepted (89% participation rate). Most visits included assessment/counseling for diet (95%), growth (84%), and safety (71%) and less often physical activity (52%) and tobacco (43%). Discussions occurring were short (median time [25th to 75th percentiles]: diet, 42 seconds [21 to 85 seconds]; safety, 24 seconds [11 to 61 seconds]; growth, 15 seconds [7 to 31 seconds]; physical activity, 12 seconds [5 to 22 seconds]; and tobacco, 3 seconds [2 to 6 seconds]). Clinicians expressed concerns about child weight during 18 of 33 visits (55%) that included an obese child and provided tobacco-related counseling at 6 of 30 visits (20%) that included a child living with a smoker. CONCLUSIONS: The PHSTS method was successfully used. Our observations found that limited time was devoted to assessment and counseling on key health topics during HSVs.

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