Reflections on well-child care practice: a national study of pediatric clinicians.

OBJECTIVE: To assess perspectives about the practice of well-child care among pediatric clinicians, especially in the areas of child development and behavior.
METHODS: Thirty-one focus groups (282 pediatricians and 41 pediatric nurse practitioners) in 13 cities addressed current practices, priorities used to determine content of well-child care visits, and changes to improve visit quality and outcomes.
RESULTS: Although most clinicians were positive about their practice of well-child care, they reported areas of concern and suggested ideas for improvements. Establishing a therapeutic relationship and individualizing care were viewed as significant contributions to quality of care. Participants agreed about the importance of eliciting parent concerns as the first priority for all well-child care visits. Community resources outside the office setting were seen as both a major influence on and, in some communities, a limitation to pediatric care. The challenges of early recognition of developmental and behavior problems through standardized questionnaires and effective interviewing were viewed as a priority to improve pediatric effectiveness in monitoring and treatment. To enhance primary care practices in developmental and behavioral pediatrics, participants suggested innovations in practice organization, community linkages, information technology, and integration of existing innovative programs. Education for pediatricians and enhanced resident training in developmental and behavioral pediatrics were endorsed.
CONCLUSIONS: Pediatric clinicians' support a vision of preventive care that is comprehensive, family centered, and developmentally relevant, both for children with greater risk to long-term healthy development and for families with more normative child-rearing concerns.