Most pediatricians give the U.S. health care system good marks when it comes to providing well-child care, but many also favor changes such as providing some care by phone or e-mail, according to a national survey.
Dr. Tumaini Coker and colleagues at the University of Chicago surveyed 502 pediatricians from around the country about their views of the current well-child system and what would be an ideal way of providing that care. Pediatricians were told to assume that their income would not be affected by the changes they were asked to evaluate for the survey.
The findings show that there is a high degree of satisfaction with the current system for providing well-child visits (Pediatrics 2006;118:1852–7). Nearly all respondents (97%) said the system was excellent or good for providing well-child visits for healthy children, 93% rated it high for chronic illness management, and 88% said it was excellent or good for providing anticipatory guidance. However, pediatricians reported that the system was less well equipped to provide psychosocial screening with only 55% rating it as excellent or good in that area.
While most of the survey respondents reported that currently they perform most components of well-child care (physician exam, anticipatory guidance, developmental screening, and psychosocial screening) themselves, in an ideal setting 55%–60% said that some of those functions could be performed by nonphysician providers.
For example, when asked who should be the main provider of services in an ideal system, 40% said that psychosocial screening should be done by the pediatrician; 40% said it should be done by a nurse practitioner or physician assistant; and 20% said it should be done by a registered nurse or medical assistant.
More pediatricians (76%) thought it was important for the pediatrician to continue to perform the physical exam in an ideal system, while the remainder said it should be done by a nurse practitioner or physician assistant.
Physicians also were supportive of replacing some in-person office visits with phone or e-mail consultations. For example, 64% of pediatricians surveyed that said much or some anticipatory guidance could be provided by phone or e-mail, and 29% said that “a few” services could be provided by phone or e-mail. In addition, 57% of pediatricians said that many or some visits for minor acute care could be handled by phone or e-mail, and 33% said that a few such visits could be replaced with calls or e-mail.
The surveys were mailed to a random national sample of 1,000 pediatricians under age 70. There was a 60% response rate, with 502 pediatricians returning the survey. The study was supported by the Robert Wood Johnson Clinical Scholars Program.
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