Seconds for Care: Evaluation of Five Health Supervision Visit Topics Using a New Method

Objective To describe content and time devoted to 5 preventive health topics during health supervision visits (HSVs). Study design New software (Pediatric Health Supervision Timer Software, PHSTS) run in handheld computers was developed to record time and content while observing HSVs. 185 visits; of children ages 2 to 10 years (58% Medicaid/self-pay to 28 clinicians were observed at 6 practices. Parents were surveyed on demographics. Data on times and actions related to assessments and counseling of growth, diet, physical activity, safety, and tobacco were collected using PHSTS. Results The PHSTS method was well accepted (89% participation rate). Most visits included assessment/counseling for die (95%), growth (84%), and safety (71%) and less often physical activity (52%) and tobacco (43%). Discussions occurring were short (median time [25th to 75th percentiles]: diet. 42 seconds 121 to 85 seconds]; safety, 24 seconds [11 to 61 seconds] growth, 15 seconds 17 to 31 seconds]; physical activity, 12 seconds 15 to 22 seconds]; mid tobacco, 3 seconds [2 to 6 seconds]) Clinicians expressed concerns about child weight during 18 of 33 visits (55%) that included fin obese child and provide( tobacco-related counseling at 6 of 30 visits (20%) that included a child living with a smoker. Conclusions The PHSTS method was successfully used. Our observations found that limited time was devoted to assessment and counseling on key health topics during HSVs. (J Pediatr 2008.153:706-11)