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A Comparison Between Family Practitioners and Pediatricians

James M. Gerard, MD; Ann E. Klasner, MD, MPH; Manu Madhok, MD, MPH; Anthony J. Scalzo, MD; Richard C. Barry, MD; Steven P. Laffey, MD

Arch Pediatr Adolesc Med. 2000;154:65-70.

Objectives  To compare the current opinions and practices of family practitioners with those of pediatricians regarding poison prevention anticipatory guidance (PPAG) and to further assess which factors, if any, are associated with providing counseling on this topic.

Design  Cross-sectional mail survey.

Participants  Family practitioners and pediatricians throughout the United States and Puerto Rico, randomly selected from the membership list of the American Medical Association.

Main Outcome Measure  Reported frequency of providing parents with PPAG.

Results  Of the 1000 physicians surveyed, 975 were eligible and 500 returned surveys that could be analyzed (227 family practitioners and 273 pediatricians), for a response rate of 51.3%. The majority of physicians in each field (family practice, 81.9%; pediatrics, 87.2%) reported that they believe it is their responsibility to provide PPAG to parents (P = .08). Family practitioners, however, were less likely than pediatricians to provide parents with PPAG (66.5% vs 91.9%; P<.001). When adjusted for other variables, such as age and sex, family practitioners were 5.4 times less likely than pediatricians to provide parents with PPAG (odds ratio, 0.19; 95% confidence interval, 0.09-0.37). Family practitioners, more often than pediatricians, cited lack of training on poisoning prevention as a reason for not providing parents with PPAG (46.1% vs 18.2%; P = .02). Among all physicians, those who received postresidency training on PPAG were more likely to provide PPAG than those who had not received postresidency training on this topic (odds ratio, 3.21; 95% confidence interval, 1.44-7.18). Having received residency training on poisoning prevention, however, did not increase the likelihood of providing PPAG (odds ratio, 1.69; 95% confidence interval, 0.86-3.30).

Conclusions  Although it is currently recommended to include PPAG as part of the routine preventive pediatric care, this study shows that one third of family practitioners do not provide parents with PPAG. Family practitioners should increase their efforts aimed at poisoning prevention. Those involved with training residents in family practice and pediatrics should place greater emphasis on this topic to increase the impact of this training on actual PPAG practices.

From the Department of Pediatrics, Divisions of Emergency Medicine (Drs Gerard, Klasner, Madhok, Scalzo, Barry, and Laffey) and Toxicology (Drs Madhok and Scalzo), Saint Louis University School of Medicine and Cardinal Glennon Regional Poison Center, St Louis, Mo.

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