Competency 10. Provide effective health maintenance and anticipatory guidance

Abstract

Health maintenance and anticipatory guidance are fundamental to pediatric practice. Up to two-thirds of pediatric office visits are for well child care, and a great portion of each well-child care visit is spent addressing behavior, development, immunizations, nutrition, and injury prevention. 1 Lopreiato J.O. Foulds D.M. Littlefield J.H. Does a health maintenance curriculum for pediatric residents improve performance?. Pediatrics. 2000; 105: 966-972 PubMed Google Scholar Many of these issues are attended to during acute care visits as well. It is therefore essential that pediatricians be trained to provide appropriate health maintenance and anticipatory guidance. “Anticipatory guidance consists of the information that clinicians give families about what they should expect in their child's development, what they should do to promote this development, and the benefits of these healthy lifestyles and practices. It is distinct from counseling, which is advice given in response to specific problems.” 2 Nelson C.S. Wissow L.S. Cheng T.L. Effectiveness of anticipatory guidance: recent developments. Curr Opin Pediatr. 2003; 15: 630-635 Crossref PubMed Scopus (83) Google Scholar Anticipatory guidance can be offered in many forms, including personal discussion, written information, video, and via the Internet. 2 Nelson C.S. Wissow L.S. Cheng T.L. Effectiveness of anticipatory guidance: recent developments. Curr Opin Pediatr. 2003; 15: 630-635 Crossref PubMed Scopus (83) Google Scholar There are several tools available that provide a systematic approach to this process. While it is clear that this is an important skill, evidence shows that physician performance in this realm is highly dependent on physician attitude, knowledge, and comfort. 3 Cardozo L.J. Steinberg J. Lepczyk M.B. et al. Improving preventive health care in a medical resident practice. Arch Intern Med. 1998; 158: 261-264 Crossref PubMed Scopus (18) Google Scholar , 4 Cheng T.L. DeWitt T.G. Savageau J.A. O'Connor K.G. Determinants of counseling in primary care pediatric practice physician attitudes about time, money, and health issues. Arch Pediatr Adolesc Med. 1999; 153: 629-635 Crossref PubMed Scopus (145) Google Scholar Another key factor is “confidence in their ability to motivate behavior change.” 4 Cheng T.L. DeWitt T.G. Savageau J.A. O'Connor K.G. Determinants of counseling in primary care pediatric practice physician attitudes about time, money, and health issues. Arch Pediatr Adolesc Med. 1999; 153: 629-635 Crossref PubMed Scopus (145) Google Scholar