Source:Barkin SL, Scheindlin B, Brown C, et al. Anticipatory guidance topics: are more better?
Ambul Pediatr

Anticipatory guidance is the cornerstone of primary care pediatrics and an integral part of health supervision visits, but little is known about what information parents recall after a visit or what factors might affect a parent’s ability to recall important information. Investigators from Wake Forest University, Winston-Salem, NC; American Academy of Pediatrics’ Pediatric Research in Office Settings (PROS), Chicago, Ill; University of Vermont, Burlington; and private practice assessed parental recall following a visit and examined how the number of topics discussed affect recall. Twenty-six practices participating in PROS enrolled parents of patients aged 2–11 years presenting for a well-child visit. Immediately after the visit, parents and providers completed surveys to record what anticipatory guidance topics were discussed during the visit. One month later, interviewers contacted participating parents by telephone and asked what they recalled discussing during the well-child visit 1 month before. The response rate to the phone survey was not noted in the article. The provider’s post-visit recall of topics discussed was the standard by which to measure what was discussed during the visit, and the parents’ post-visit recall and 1-month recall were compared with this report. Parents were classified into 3 groups according to the number of topics discussed during the well-child visit: low (1–4 topics), medium (5–8 topics), and high (9 or more).

A total of 861 parents were seen by 32 practitioners from 26 practices located in 20 states and Canada. Overall, providers reported discussing the topics of car restraints, nutrition, dental care, and reading aloud most frequently (72%–93%) and the majority (53%) indicated discussing between 5 and 8 anticipatory guidance topics. For children ages 2–5, providers most frequently discussed discipline and medication storage. For children ages 6–11, providers more often discussed TV/computer games, bike helmets, regular exercise, smoking around children, guns, and family fights. The mean number of topics discussed for children ages 2–5 years (6.5) differed significantly from the number of topics discussed for children 6–11 years (7.4) (P<.0001).

Immediately post visit, parents and providers indicated good agreement (72%–90%) about what topics were discussed. Parents recalled more topics than the provider reported when a low number of topics had been discussed (both immediately following the visit and at 1 month). The best agreement between parent and provider reports existed when a medium number of topics were discussed (5–8 topics). When a high number of topics were discussed (>9), providers reported discussing more than parents recalled. This same pattern emerged 1 month later: parents and providers reported similar numbers of topics when a medium number of topics had been presented (6.83 reported by the parent at 1 month compared with 6.49 reported by the provider immediately following the visit), and when a high number of topics was presented, parents recalled fewer topics discussed than providers had reported immediately following the visit (8.63 vs 10.1).

Dr. Fimbres has disclosed no...

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