P E R F O R M I N G P R E V E N T I V E S E R V I C E S : A B R I G H T F U T U R E S H A N D B O O K
EDWARD L. SCHOR, MD
Well-child care accounts for 25% of visits to primary care practitioners for children
younger than 15 and 40% for children younger than 1 year.1 These visits constitute
a large percentage of pediatricians’ time, with the average time for preventive care
visits ranging from 16 to 19 minutes2–4 (slightly more for adolescent visits5).
Although pediatricians and parents are generally satisﬁed with the time available
for these visits,4 some ambivalence remains. Most pediatricians (53%) report that
they have enough time,6 but many say lack of time (85%) and the need to prioritize
among preventive care topics (47%) are barriers to implementing recommended
preventive care services.5 Parents do not always have suﬃcient time to have their
needs fully addressed. Though most (88%) report having enough time during
preventive care visits, a signiﬁcant number of parents (34%) say they were not
able to ask all of their questions.7
Responding to the Population Served Meeting the speciﬁc needs of the individual child
and family requires that the practitioner ﬁrst gather
Pediatricians individualize care by making choices about information and then provide services that are
what to include and omit during well-child care visits. appropriate for the child’s level of risk and development.
Little information is available about what guides these Some information is obtained through standardized
decisions but, ideally, pediatricians are considering (1) assessments, with a special focus on child development
the needs of the families and community they serve, (2) and behavior and the psychosocial issues faced by the
the needs of the child and family, (3) the outcomes they family. In general, lower-risk families receive services
intend to achieve, and (4) the preferences of the parents primarily intended to promote optimal development to
and child. prevent the onset of illness or injury. Higher-risk families
may receive similar primary prevention services and, in
Successful pediatric practices prioritize care based on a
addition, are given detection and intervention services
general understanding of their patient populations. This
to reduce the likelihood of health or developmental
means they are able to respond not only to the needs of
problems becoming clinically apparent. Preventive care
individual families, but also to the community as a whole.
for children with established, chronic problems should
Practices can structure their care to be eﬃcient and
also include services to minimize the progression of their
eﬀective by knowing the demographics of the families
conditions so they do not further limit the child’s physical,
they serve, the resources available in their community, 8emotional, or social functioning.
and through relationships with other professionals who
serve or care for their patients.