BACKGROUND: The AAP recommends periodic administration of standardized developmental screens during well child visits to facilitate identification of developmental delays. However, little is known about how parents and physicians communicate about development, or how screening impacts communication.
OBJECTIVE: 1) To describe communication about development between parents and pediatricians. 2) To determine effect on communication of PEDS parent concern screener, with or without video presentation on developmental skills.
DESIGN/METHODS: 6 primary care pediatricians in Ohio participated. 15 parents of children 9-31 mos of age per pediatrician were assigned to 1 of 3 groups: 1) usual care; 2) parent completed PEDS screener; or 3) parent completed PEDS after viewing 5-minute video on development, importance of parent input, and Early Intervention (EI). 89 visits were audiotaped and coded by blinded raters using a classification system of communication content. Inter-rater reliability was established by comparing 2 raters' coding of 19 tapes. Outcomes: a) visit length; b) physicians: # of open-ended questions about development or health; and close-ended questions, information giving, reassurance or counseling about development; c) parents: # of developmental or health questions or concerns; and d) requests for developmental services. Group means were adjusted for clustering by physician using mixed model methods.
RESULTS: Mean child age 17.1 mos; 77% Medicaid insured. Mean visit duration was similar for the 3 groups. Physicians: no difference in use of open or close-ended questions or statements of reassurance; but more information-giving and counseling statements about development, and more developmental concerns raised in group 3 (PEDS plus video) than 1 (usual care) (p<0.05). Parents: no difference in developmental or health-related questions, but more likely to raise a developmental concern in group 3 than 1 (p<0.05), but not group 2 (PEDS only). No parent requested EI. Overall, 4 children were referred to EI, 3 from group 3.
CONCLUSIONS: Use of the PEDS did not increase mean visit duration. Although the PEDS alone did not change parent-physician communication in this inner-city sample, addition of a brief parent activation video was associated with an increase in physician and parent communication about developmental concerns. Most children referred to EI were in the PEDS plus video group, suggesting an effect from this intervention.
Comments from Frances Glascoe:
I'm a bit confused by this one as to whether Dr. Sices counted the concerns raised on PEDS or just any new concerns raised AFTER the administration PEDS. And...whether these were first time administrations of PEDS (in which parents are a bit more quiet than they are the second time through). I'll update this as the more information comes my way. Anyway, the visit length issue is interesting--as is the fact that we really need to encourage parents to talk with providers.
: L. Sices, A. Keilman, H.L. Kirchner, D. Roberts, T. Stancin.. Pediatrics, Boston Medical Center, Boston, MA; Case Western Reserve University, Cleveland, OH; Geisinger Medical Center, Danville, PA; Pediatrics, MetroHealth Medical Center, Cleveland, OH.
Presentation to the Annual Meeting of the Pediatric Academic Societies, May 20Source