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December 2007

Discussion of Illness During Well-Child Care Visits With Parents of Children With and Without Special Health Care Needs

Author Affiliations

Author Affiliations: Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, Boston, Massachusetts (Dr Van Cleave); Veterans Affairs Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System (Dr Heisler), and Department of Internal Medicine, Michigan Diabetes Research and Training Center (Dr Heisler), Division of General Pediatrics (Drs Joiner and Davis), Child Health Evaluation and Research Unit (Dr Davis), Division of General Internal Medicine (Dr Davis), and Gerald R. Ford School of Public Policy (Dr Davis), University of Michigan, Ann Arbor; and Children's Hospital of Michigan, Detroit (Dr Devries).

Arch Pediatr Adolesc Med. 2007;161(12):1170-1175. doi:10.1001/archpedi.161.12.1170

Objectives  To compare parents of children with special health care needs (CSHCN) with other parents to determine parents' expectations and priorities for discussing concerns related to a child's acute or chronic illness at well-child care visits, the association of unmet expectations and priorities with satisfaction, and whether discussing illness displaces prevention topics.

Design  Written, self-administered survey of parents at well-child care visits.

Setting  Two community-based pediatric practices in suburban southeast Michigan.

Participants  Five hundred parents with children aged 6 months to 12 years.

Main Exposure  Having a special health care need.

Main Outcome Measures  Expectations and priorities for discussing illness-related topics (chronic and acute illnesses, medications, specialist referrals, and effects of health on life overall), actual discussion regarding illness and preventive topics, and satisfaction.

Results  Compared with parents of children without chronic conditions, parents of CSHCN were more likely to expect to discuss their child's illness (81% vs 92%, respectively; P < .001); 79% of parents of CSHCN ranked illness among their top 3 priorities (vs 53% of other parents [P < .001]). Parents of CSHCN reported discussing a mean of 3.2 illness topics, as compared with a mean of 2.2 illness topics for other parents (P < .001). Having more than 1 unmet expectation for discussing illness was associated with higher odds of lower satisfaction (for parents of CSHCN: odds ratio, 7.2; 95% confidence interval, 2.9-18.3; for other parents: odds ratio, 3.0; 95% confidence interval, 1.7-5.5). Discussing more illness topics was associated with discussing more preventive topics (P < .001).

Conclusions  Discussing illness is frequently expected and highly prioritized at well-child care visits, particularly for parents of CSHCN. Unmet expectations are associated with lower satisfaction. Incorporating illness concerns at well-child care visits may improve chronic disease management.