Effect of a pediatric self-care book on utilization of services in a group model HMO.

Abstract

The purpose of this study was to determine the effect of a pediatric self-care book (SCB) with nurse telephone support on use of health services. The study was performed in a pediatric department of Kaiser Permanente in a suburb of Denver, Colorado. Well patients seen at age 2 weeks to 2.5 months (infant group) or 14 to 19 months (toddler group) were enrolled. Intervention families received a copy of the book, Your Child's Health and were oriented on its use. Rates of sick visits, advice nurse calls, pharmacy prescriptions, emergency department visits, and hospital admissions were assessed. Visit and call rates were calculated, and mean rates of the SCB group and the control group were then compared. Of 1,104 enrols, 527 received the SCB; the other 577 served as controls. The SCB group had 14.0% fewer total visits (excluding well-baby visits) than controls did (p = 0.018). For infants and toddlers who were not first-borns, the intervention was associated with a statistically significant decrease in sick visits (23%), advice nurse phone calls (24%), and pharmacy prescriptions (26%); no statistically significant differences in study outcomes were seen among first-born study subjects. Promotion of self-care in a group model health maintenance organization can decrease use of services by families of young children.