This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (26)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Pediatrics, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Charles W. LeBaron, MD; Lance Rodewald, MD, MS; Sharon Humiston, MD, MPH

Arch Pediatr Adolesc Med. 1999;153:1154-1159.

Context  Because well-child care represents the most important prevention opportunity in the health care system, a growing number of activities and indicators have been proposed for it.

Objective  To measure the time spent in the various components of well-child care.

Design  Time-and-motion study.

Setting  Five private pediatric practices and 2 public providers in Rochester, NY.

Participants  One hundred sixty-four children younger than 2 years.

Main Outcome Measure  Duration of family's encounters with the primary care provider (physician or nurse practitioner), nurse, and other personnel.

Results  The median encounter times and their component parts in minutes were: (1) primary care provider, 16.3 (physical examination, 4.9; vaccination discussion, 1.9; discussion of other health issues, 9.5; vaccination administration, 0); (2) nurse, 5.6 (physical examination, 3.5; vaccination discussion, 0; other health discussion, 0; vaccine administration, 1.6); and (3) other personnel, 0 for all categories. Public provider setting, African American race of the child, and administration of 4 vaccinations were significantly associated with an increase (3-4 minutes) in the duration of the primary care provider encounter. Only 8 (5%) of families read vaccine information materials.

Conclusions  Depending on whether a child makes the usual 3 or recommended 6 number of well-child visits, the total time of well-child care is 45 to 90 minutes during the first year of life and declines to less than 30 minutes per year thereafter as the number of recommended visits diminish. Because high-risk children make half as many well-child care visits as other children, a 3 to 4 minute increase in encounter time is insufficient to provide them with the same level of care as other children.

From the National Immunization Program, Centers for Disease Control and Prevention, Public Health Services, US Department of Health and Human Services, Atlanta, Ga (Drs LeBaron, Rodewald, and Humiston); and the Departments of Emergency Medicine and Pediatrics, the University of Rochester School of Medicine, Rochester, NY (Drs Rodewald and Humiston).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Health Supervision Visits of Very Young Children: Time Addressing 3 Key Topics
Manning et al.
CLIN PEDIATR 2009;48:931-938.
ABSTRACT  

Relationship Between Parenting Stress and Concerns Identified by Developmental Screening and Their Effects on Parental Medical Care--Seeking Behavior
Voigt et al.
CLIN PEDIATR 2009;48:362-368.
ABSTRACT  

Communication About Child Development During Well-Child Visits: Impact of Parents' Evaluation of Developmental Status Screener With or Without an Informational Video
Sices et al.
Pediatrics 2008;122:e1091-e1099.
ABSTRACT | FULL TEXT  

Is Office-Based Counseling About Media Use, Timeouts, and Firearm Storage Effective? Results From a Cluster-Randomized, Controlled Trial
Barkin et al.
Pediatrics 2008;122:e15-e25.
ABSTRACT | FULL TEXT  

Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?
Broder et al.
Pediatrics 2008;121:S25-S34.
ABSTRACT | FULL TEXT  

Parent Use of Touchscreen Computer Kiosks for Child Health Promotion in Community Settings
Thompson et al.
Pediatrics 2007;119:427-434.
ABSTRACT | FULL TEXT  

Improving Pediatric Prevention via the Internet: A Randomized, Controlled Trial
Christakis et al.
Pediatrics 2006;118:1157-1166.
ABSTRACT | FULL TEXT  

Thoughts on health supervision: learning-focused primary care.
Needlman
Pediatrics 2006;117:e1233-e1236.
ABSTRACT | FULL TEXT  

Qualitative Analysis of Mothers' Decision-Making About Vaccines for Infants: The Importance of Trust
Benin et al.
Pediatrics 2006;117:1532-1541.
ABSTRACT | FULL TEXT  

Can an Information Prescription Change Parental Attitudes and Behaviors Related to Using the Internet for Health Information Resources?
Kind et al.
Arch Pediatr Adolesc Med 2004;158:864-866.
FULL TEXT  

The Cost of Giving Childhood Vaccinations: Differences Among Provider Types
Glazner et al.
Pediatrics 2004;113:1582-1587.
ABSTRACT | FULL TEXT  

Detection of Postpartum Depressive Symptoms by Screening at Well-Child Visits
Chaudron et al.
Pediatrics 2004;113:551-558.
ABSTRACT | FULL TEXT  

Family Pediatrics: Report of the Task Force on the Family
American Academy of Pediatrics
Pediatrics 2003;111:1541-1571.
ABSTRACT | FULL TEXT  

Time Spent by Primary Care Practices on Pediatric Influenza Vaccination Visits: Implications for Universal Influenza Vaccination
Szilagyi et al.
Arch Pediatr Adolesc Med 2003;157:191-195.
ABSTRACT | FULL TEXT  

Ease of Administration of the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) During Pediatric Well-Child Visits
Pittock et al.
CLIN PEDIATR 2002;41:397-403.
ABSTRACT  

Childhood Vaccination Providers in the United States
LeBaron et al.
AJPH 2002;92:266-270.
ABSTRACT | FULL TEXT  

Parental Perceptions of Well-Child Care Visits in an Inner-city Clinic
Busey et al.
Arch Pediatr Adolesc Med 2002;156:62-66.
ABSTRACT | FULL TEXT  

The Cost to Immunize During Well-Child Visits
Fontanesi et al.
American Journal of Medical Quality 2001;16:196-201.
ABSTRACT  

Vaccination Coverage and Physician Distribution in the United States, 1997
LeBaron et al.
Pediatrics 2001;107:31e-31.
ABSTRACT | FULL TEXT  

Childhood Vaccine Risk/Benefit Communication in Private Practice Office Settings: A National Survey
Davis et al.
Pediatrics 2001;107:17e-17.
ABSTRACT | FULL TEXT