PREVENTIVE CARE FOR CHILDREN IN THE UNITED STATES: Quality and Barriers

Abstract

Key Words primary health care, well-child care, adolescent, child, infant ■ Abstract Our objective was to examine the academic literature covering quality of childhood preventive care in the United States and to identify barriers that contribute to poor or disparate quality. We systematically reviewed articles related to childhood preventive care published from 1994 through 2003, focusing on 58 large observational studies and interventions addressing well-child visit frequency, developmental and psychosocial surveillance, disease screening, and anticipatory guidance. Although many children attend recommended well-child visits and receive comprehensive preventive care at those visits, many do not attend such visits. Estimates of children who attend all recommended visits range widely (from 37%-81%). In most studies, less than half is the proportion of children who receive developmental or psychosocial surveillance, adolescents who are asked about various health risks, children at risk for lead exposure who are screened, adolescents at risk for Chlamydia who are tested, or children and adolescents who receive anticipatory guidance on various topics. Major barriers include lack of insurance, lack of continuity with a clinician or place of care, lack of privacy for adolescents, lack of clinician awareness or skill, racial/ethnic barriers, language-related barriers, clinician and patient gender-related barriers, and lack of time. In summary, childhood preventive care quality is mixed, with large disparities among populations. Recent research has identified barriers that might be overcome through practice and policy interventions.

A Novel Triage Approach to Identifying Health Concerns

“…[3][4][5][6][7] However, awareness is growing that preventive services for children must be conducted more cost-efficiently and in better alignment with current health system issues, such as improved use of physician and nurse competence, evolving health priorities, inequities in health, and uneven access to preventive care. [8][9][10][11] Many countries have preventive child health care (PCH) programs for universal routine child health assessments, and vaccination programs. The Netherlands has a free PCH program for all children aged 0 to 18 years, including ∼17 routine health assessments.…”

Preterm Infant Attendance at Health Supervision Visits

“…[16][17][18][19][20][21][22][23][24][25][26][27][28] These studies mainly involve claims and surveys, with surveys more likely to reflect increased adherence with care. 29 Children with special health care needs have been reported to have similar or higher rates of adherence compared with those without special needs. 16,19 There has been only 1 study, limited to children receiving Medicaid, that compared late preterm to term children and found similar rates of adherence.…”

Well-Child Care Clinical Practice Redesign for Serving Low-Income Children

“…[2][3][4][5][6] Pediatric providers are currently not providing many important recommended preventive and developmental services, and most parents leave visits with unmet WCC needs. [2][3][4]7 Many of these deficiencies occur more frequently among children in low-income families. 5 Practice redesign may create a more effective and efficient system of health care delivery.…”