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Health Promotion in Pediatric Practice

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Project Summary:

The provision of health supervision during childhood is a complex process. There are many areas of health and behavior to assess, and on which to provide guidance, in a limited amount of time. There is a need to better understand how tobacco-related messages fit into the array of prevention messages and to quantify the time involved in their routine application. This understanding will allow the development of approaches to increase preventive service delivery. This study is a supplement to the parent grant entitled, "Healthy Families, Healthy Children: the Pediatrician's Role." That study evaluates two levels of intervention applied at pediatric practices aimed at enhancing the delivery of tobacco-related assessments and counseling. This study will accomplish the following aims: Demonstrate a means to measure time allotted for tobacco and other key aspects of preventive care. Test the effect of an intervention on the routine discussion of tobacco issues during health supervision visits. Test the effect of an intervention on time devoted to tobacco issues at health supervision visits, using time as an absolute measure and time as a percentage of the total visit. At each of two time periods (baseline and one year after intervention), data will be collected on 180 health supervision visits of children 2-10 years of age being seen at 6 pediatric offices. Data methods include the use of handheld computers during visual observation of well-child visits to demonstrate a new method of evaluating visit time related to tobacco use assessment and counseling. We will measure time devoted to assessment and counseling for other aspects of preventive care (growth, diet, physical activity, and safety). This will allow us to examine how a focused intervention on tobacco impacts time related to other aspects of care. Other data measures will assess the practice environment (through a structured interview) and provider's usual care delivery patterns (through a provider-completed survey). Following each observed visit, the parent will compete a short survey, which includes information on family tobacco use. In addition, the child's medical record will be reviewed. Outcomes of interest include time spent in tobacco assessment, time spent in tobacco counseling, percent of time spent on tobacco issues versus all other assessment and counseling activities, frequency of mention of tobacco issues among visits and practices, the position of the person doing the counseling (provider versus staff), and the frequency of identification of family tobacco use. Analysis of variance models will be used to examine the effect of various child/family or provider characteristics on time spent in tobacco-related care delivery. Reports will include descriptions of visit routines and activities related to health promotions assessments and preventive counseling actions. The relationship between time devoted to health assessment and counseling activities for tobacco, time devoted to other issues, and changes in such after interventions are applied will be reported. This study will provide valuable new information related to tobacco issues in pediatric practice and demonstrate a new evaluation method to measure time devoted to this aspect of care.

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