A case study of well child care visits at general practices in a region of disadvantage in Sydney.

Pankaj Garg,Siaw-Teng Liaw,Rebekah Grace,Bin Jalaludin,John Eastwood,Ann Yeh

doi:10.1371/journal.pone.0205235

Abstract

IntroductionWell-Child Care (WCC) is the provision of preventive health care services for children and their families. Prior research has highlighted that several barriers exist for the provision of WCC services.ObjectivesTo study “real life” visits of parents and children with health professionals in order to enhance the theoretical understanding of factors affecting WCC.MethodsParticipant observations of a cross-sectional sample of 71 visits at three general practices were analysed using a mixed-methods approach.ResultsThe median age of the children was 18 months (IQR, 6–36 months), and the duration of visits was 13 mins (IQR, 9–18 mins). The reasons for the visits were immunisation in 13 (18.5%), general check-up in 10 (13.8%), viral illness in 33 (49.2%) and miscellaneous reasons in 15 (18.5%). Two clusters with low and high WCC emerged; WCC was associated with higher GP patient-centeredness scores, younger age of the child, fewer previous visits, immunisation and general check-up visits, and the solo general practitioner setting. Mothers born overseas received less WCC advice, while longer duration of visit increased WCC. GPs often made observations on physical growth and development and negotiated mothers concerns to provide reassurance to them. The working style of the GP which encouraged informal conversations with the parents enhanced WCC. There was a lack of systematic use of developmental screening measures.ConclusionsGPs and practice nurses are providing parent/child centered WCC in many visits, particularly when parents present for immunisation and general check-ups. Providing funding and practice nurse support to GPs, and aligning WCC activities with all immunisation visits, rather than just a one-off screening approach, appears to be the best way forward. A cluster randomised trial for doing structured WCC activities with immunisation visits would provide further evidence for cost-effectiveness studies to inform policy change.

Highlights

Well-Child Care (WCC) is the provision of preventive health care services for children and their families
Two clusters with low and high WCC emerged; WCC was associated with higher General Practitioners (GPs) patient-centeredness scores, younger age of the child, fewer previous visits, immunisation and general check-up visits, and the solo general practitioner setting
GPs and practice nurses are providing parent/child centered WCC in many visits, when parents present for immunisation and general check-ups

Summary

Introduction

Well-Child Care (WCC) is the provision of preventive health care services for children and their families. Well-Child Care (WCC) is the provision of preventive primary health care services for children and their families It involves the delivery of anticipatory guidance, developmental screening and surveillance, immunisation, child and family psychosocial assessments and care co-ordination [1, 2]. It aims to support parents’ knowledge about their children’s development, improve parent-child interactions, reduce avoidable hospitalisations and emergency department visits, and has the potential to modify parenting practices in terms of healthcare-seeking behaviour, promotion of positive dietary and feeding practices, and management of common childhood infections [3,4,5,6,7]. WCC has an important role to play in the identification and referral to appropriate early childhood intervention services that will support families and improve child outcomes [13, 14]

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