by: posted Thursday, September 22, 2011
For new parents, advice from their pediatrician about soothing a crying infant or putting them to sleep is invaluable and often discussed at well-baby check-ups. But a study published Monday in the journal Pediatrics found that a third of the time parents of young children spent 10 minutes less in the exam for a those check-ups and this may be depriving families of important preventive care for their children.
When doctors were asked how much time was needed for a well visit, they said on average about 17 minutes, according to the study.
Why the time crunch? Experts say doctors are being asked to do more in less time and though they would like to provide more care, they can't make it happen. The American Academy of Pediatrics (AAP) has specific guidelines for what pediatricians and families need to discuss during these regularly check-ups, which are not only for newborn, but are also recommended for children all the up to age 21. While breast feeding, sleep positions, language development, and keeping your child safe are top priorities for parents of infants, pediatricians can also provide guidance and children get older, including how to toilet-train, deal with discipline issues, or how your child gets along with others.
But some of these well-child visits are not always covered by health insurance. Some insurance companies pay nothing for these visits; others only pay for a certain number of these appointments each year. Though the advent of HMOs has generally increased reimbursement levels, preventive care as a whole is still under-reimbursed and not looked upon as providing enough value for the expense, according to the AAP.
What's discussed in these wellness visits has evolved. In the 1960s and '70s doctors focused more on preventing infectious diseases such as polio, measles, and mumps. With the development of more vaccines, doctors are seeing fewer and fewer children with these illnesses.
"What we see more of now is disorders of anxiety, disorders of mood... depression, ADHD, drug and alcohol use...and autism," explains Dr. Joseph Hagan, Chairman of the AAP's Bright Futures Steering Committee. Many of these conditions need screening to detect, and that takes time. Also, if these behavioral and other health problems aren't detected in early, childhood issues can become even bigger problems in adulthood. Health problems such as obesity, diabetes, and mental health concerns often manifest by adolescence.
"If we're really interested in reducing the impact and cost of chronic disease in our society, then we need to focus more on children's health and those things we can prevent and better understand what we can do," explains Dr. Neal Halfon, Director of the UCLA Center for Healthier Children, Families, and Communities in Los Angeles, California and lead study author.
Halfon says there are things that pediatricians, parents and insurance providers can be do to address the time constraints often tied to preventive care:
1) Higher reimbursement for preventive care
2) A team approach to care so that non-physicians handle some of the screenings or other needs
3) Use of pre-visit questionnaires so clinicians can better prepare for visits
4) A tiered system so that higher risk children can get longer office visits
Parents can also learn to better use the short amount of time they have with their pediatrician.
"Be prepared when you go see your physician and use the time wisely," explains Halfon. "Make sure that you're asking the questions that you need to ask and that you're getting the answers you need."
FULL SOURCE: thechart.blogs.cnn.com/2011/09/19/doctor-my-child-and-i-need-more-time-with-you/