Enhanced Well Child Visits in a Primary Care Setting: Overview and Experiences

Enhanced Well Child Visits in a Primary Care Setting: Overview and Experiences

Research by: Amra Dizdarevic, BSc, BSN, MN-NP, Karin Dixon, BNSc, MN-NP, Holly Kennedy-Symonds, MHSc

Presented at: Accelerating Primary Care Conference 2014 in West Edmonton

Context

research_enhanced-well-child-visits

Primary care providers have a tremendous potential to positively affect outcomes through regular contact with children and families, not only in the early years, but throughout childhood. However, there are no regularly scheduled well child visits between 18 month and preschool years and none after school entry – this creates a gap in care. To address this gap in care to some degree, the Canadian Pediatric Society recommended introduction of an enhanced well child visit at 18 months of age. However, children of all ages would benefit from enhanced well child visits and from regularly scheduled contact with their primary care providers throughout childhood.

Objective

To provide regularly scheduled enhanced well child visits to all children up to age 18.

Participants and Methods

1257 children are enrolled in the Copeman Kids program at 4 Copeman Healthcare Centres (Vancouver, West Vancouver,
Calgary and Edmonton). Infants are seen at 2, 4, 6, 9, 12, 15 and 18 months of age. After age 2, children are seen annually.

Visits were organized systematically to incorporate:

  • A physician-prompt health supervision guide with evidence informed suggestions for health promotion and illness prevention (Rourke Baby Record (up to age 6) & Greig Health Record (age 6 to 17))
  • A developmental screening tool for all children up to 5 years of age using the Ages and Stages Questionnaire
  • A behavioural screening tool for children 5-18 years of age using the Strengths and Difficulties Questionnaire
  • A screen for autism spectrum disorders at 18 and 24 months (MCHAT-R)

Results

  • Over the past two years, provision of enhanced well child visits enabled clinicians to measure and monitor key indicators of childhood health and well-being
  • Qualitative review indicates that children and parents demonstrated increased knowledge and change in their health behaviours and reported higher satisfaction with care. Quantitative review to follow.
  • Nurse practitioners and family physicians improved patient outcomes through a systematic approach to care and by creating an effective and efficient working culture and communication system.

Conclusions

The provision of regularly scheduled, enhanced well child visits to all children up to 18 years of age resulted in improved health behaviours of children and parents and higher satisfaction with care.

Click here to view the complete poster as presented at APCC 2014, including supporting figures