A case study of well child care visits at general practices in a region of disadvantage in Sydney

Abstract

IntroductionWell-Child Care (WCC) is the provision of preventive health care services for children and their families. Prior research has highlighted that several barriers exist for the provision of WCC services.ObjectivesTo study “real life” visits of parents and children with health professionals in order to enhance the theoretical understanding of factors affecting WCC.MethodsParticipant observations of a cross-sectional sample of 71 visits at three general practices were analysed using a mixed-methods approach.ResultsThe median age of the children was 18 months (IQR, 6–36 months), and the duration of visits was 13 mins (IQR, 9–18 mins). The reasons for the visits were immunisation in 13 (18.5%), general check-up in 10 (13.8%), viral illness in 33 (49.2%) and miscellaneous reasons in 15 (18.5%). Two clusters with low and high WCC emerged; WCC was associated with higher GP patient-centeredness scores, younger age of the child, fewer previous visits, immunisation and general check-up visits, and the solo general practitioner setting. Mothers born overseas received less WCC advice, while longer duration of visit increased WCC. GPs often made observations on physical growth and development and negotiated mothers concerns to provide reassurance to them. The working style of the GP which encouraged informal conversations with the parents enhanced WCC. There was a lack of systematic use of developmental screening measures.ConclusionsGPs and practice nurses are providing parent/child centered WCC in many visits, particularly when parents present for immunisation and general check-ups. Providing funding and practice nurse support to GPs, and aligning WCC activities with all immunisation visits, rather than just a one-off screening approach, appears to be the best way forward. A cluster randomised trial for doing structured WCC activities with immunisation visits would provide further evidence for cost-effectiveness studies to inform policy change.

Improving assessment of child development: Results of a quality improvement intervention in general practice

“…The US study found that more behavioural and developmental concerns were detected using PEDS and generated more referrals. (13) Outcomes from our study were limited by small numbers of "positive" PEDS screening questionnaires, but our qualitative research, and that of others, (14) suggest that knowledge of outcomes of screening is important for clinicians to remain motivated.…”

Routine developmental screening in Australian general practice: a pilot study

“…Comments from some clinicians in this study reflected reasons uncovered by other researchers that may explain a reluctance to participate in screening: an over-reliance on clinical impressions [ 21 , 22 ] failure to recognise parents’ concerns [ 21 , 23 ] and a lack of knowledge about the benefits of validated screening tools. [ 7 , 24 ]. Garg et al highlight the need for further training and recommend practice nurse support for GPs conducting developmental screening [ 7 ].…”

“…[ 7 , 24 ]. Garg et al highlight the need for further training and recommend practice nurse support for GPs conducting developmental screening [ 7 ].…”

“…However, time constraints and lack of knowledge of child developmental screening instruments are barriers to GP-led developmental surveillance (Fig. 1 ) [ 7 ].

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The effect of swaddling on infant sleep and arousal: A systematic review and narrative synthesis

“…This mixed-methods approach is thought to provide a more complete basis for complex clinical and policy decision-making than that currently offered by single method reviews ( 4 ). It was particularly appropriate for the present review question, as swaddling is not only a physiological intervention but also a social one; its application differs across and within cultures according to numerous diverse factors such as tradition, health professional advice, policy recommendations, fashion and personality ( 5 – 8 ). The objective of this mixed-methods approach is therefore to integrate a quantitative estimation of swaddling's “effectiveness” via measures of infant sleep duration and arousal, with a more qualitative understanding from the perspective of the implementers of the intervention (usually parents), increasing the relevance of the review for policy and practice.…”