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Screening for Behavioral Risk Factors Is Not Enough to Improve Preventive Services Delivery

  • Olivier Drouin
    Correspondence
    Address correspondence to Olivier Drouin, MDCM, MSc, MPH, Division of General Pediatrics, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, 7e étage, bloc 9, Montréal, Québec H3T 1C5, Canada ().
    Affiliations
    Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, Mass

    Harvard-wide Pediatric Health Services Research Fellowship, Boston, Mass
    Search for articles by this author
  • Jonathan P. Winickoff
    Affiliations
    Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, Mass

    Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Elk Grove Village, Ill
    Search for articles by this author
Published:January 21, 2018DOI:https://doi.org/10.1016/j.acap.2018.01.008

      Abstract

      Objective

      Unhealthy behaviors are a major cause of chronic disease. Preappointment screening has been suggested as one way to improve preventive care delivery related to these behaviors by specifying risks to be addressed. We aimed to determine whether screening for health-related behaviors before the clinical encounter will lead to higher counseling rate and service delivery by clinicians.

      Methods

      We used a pre/post design in one practice with a control practice to evaluate the effects of preappointment screening for 3 behavioral risk factors (tobacco smoke exposure, no recent dental care visit, and consumption of sugar-sweetened beverages). After their clinic visit, we asked English-speaking parents whose child had one or more risk factor whether they had received counseling or services from their pediatrician to address them.

      Results

      We recruited 264 parents in the pre phase and 242 in the post phase. Among 215 parents whose child had one or more risk factors, parents in the post phase were as likely to report receiving counseling than parents in the pre phase for each of the risk factors: smoking odds ratio 6.75 (95% confidence interval, 0.51, 88.88), dental health odds ratio 1.44 (95% confidence interval, 0.47, 4.41), and sugar-sweetened beverage consumption odds ratio 0.34 (95% confidence interval, 0.23, 5.18). Service delivery and reported behavior change were also similar in both phases.

      Conclusions

      Counseling rates for tobacco, dental health, or sugar-sweetened beverage consumption were low in pediatric primary care, and preappointment screening did not significantly affect clinician counseling. Future efforts will require a more robust approach to effect change in counseling, provision of service, and family behavior.

      Keywords

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      References

        • HealthyPeople.gov
        2020 topics and objectives.
        (Available at)
        • American Academy of Pediatrics
        Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents.
        American Academy of Pediatrics, Elk Grove Village, Ill2013: 147-154
        • Alamian A.
        • Paradis G.
        Clustering of chronic disease behavioral risk factors in Canadian children and adolescents.
        Prev Med. 2009; 48: 493-499
        • Halfon N.
        • Hochstein M.
        Life course health development: an integrated framework for developing health, policy, and research.
        Milbank Q. 2002; 80 (iii): 433-479
        • Van Cleave J.
        • Gortmaker S.L.
        • Perrin J.M.
        Dynamics of obesity and chronic health conditions among children and youth.
        JAMA. 2010; 303: 623-630
        • Centers for Disease Control and Prevention
        Vital signs: nonsmokers' exposure to secondhand smoke—United States, 1999–2008.
        MMWR Morb Mortal Wkly Rep. 2010; 59: 1141-1146
        • Cluss P.A.
        • Moss D.
        Parent attitudes about pediatricians addressing parental smoking.
        Ambul Pediatr. 2002; 2: 485-488
        • Winickoff J.P.
        • McMillen R.C.
        • Carroll B.C.
        • et al.
        Addressing parental smoking in pediatrics and family practice: a national survey of parents.
        Pediatrics. 2003; 112: 1146-1151
        • Winickoff J.P.
        • Nabi-Burza E.
        • Chang Y.
        • et al.
        Implementation of a parental tobacco control intervention in pediatric practice.
        Pediatrics. 2013; 132: 109-117
        • Winickoff J.P.
        • Buckley V.J.
        • Palfrey J.S.
        • et al.
        Intervention with parental smokers in an outpatient pediatric clinic using counseling and nicotine replacement.
        Pediatrics. 2003; 112: 1127-1133
        • Winickoff J.P.
        • Berkowitz A.B.
        • Brooks K.
        • et al.
        State-of-the-art interventions for office-based parental tobacco control.
        Pediatrics. 2005; 115: 750-760
        • National Institute of Dental and Craniofacial Research
        Oral health in America: a report of the Surgeon General.
        (Available at)
        • Hu F.B.
        Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases.
        Obes Rev. 2013; 14: 606-619
        • Malik V.S.
        • Pan A.
        • Willett W.C.
        • et al.
        Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis.
        Am J Clin Nutr. 2013; 98: 1084-1102
        • DeBoer M.D.
        • Scharf R.J.
        • Demmer R.T.
        Sugar-sweetened beverages and weight gain in 2- to 5-year-old children.
        Pediatrics. 2013; 132: 413-420
        • Marshall T.A.
        • Levy S.M.
        • Broffitt B.
        • et al.
        Dental caries and beverage consumption in young children.
        Pediatrics. 2003; 112: e184-e191
        • American Academy of Pediatrics
        Performing Preventive Services: A Bright Futures Handbook.
        American Academy of Pediatrics, Elk Grove Village, Ill2010
        • Lee J.Y.
        • Bouwens T.J.
        • Savage M.F.
        • et al.
        Examining the cost-effectiveness of early dental visits.
        Pediatr Dent. 2006; 28: 102-105
        • Sim L.A.
        • Lebow J.
        • Wang Z.
        • et al.
        Brief primary care obesity interventions: a meta-analysis.
        Pediatrics. 2016; 138
        • American Academy of Pediatrics
        Bright Futures pocket guide.
        (Available at)
        • Mangione-Smith R.
        • DeCristofaro A.H.
        • Setodji C.M.
        • et al.
        The quality of ambulatory care delivered to children in the United States.
        N Engl J Med. 2007; 357: 1515-1523
        • Rand C.M.
        • Blumkin A.
        • Szilagyi P.G.
        Electronic health record use and preventive counseling for US children and adolescents.
        J Am Med Inform Assoc. 2014; 21: e152-e156
        • Winickoff J.P.
        • McMillen R.
        • Klein J.D.
        The Joint Commission's new tobacco-cessation measures.
        N Engl J Med. 2012; 366: 2429
        • Coker T.R.
        • Thomas T.
        • Chung P.J.
        Does well-child care have a future in pediatrics?.
        Pediatrics. 2013; 131: S149-S159
        • Chung P.J.
        • Lee T.C.
        • Morrison J.L.
        • et al.
        Preventive care for children in the United States: quality and barriers.
        Annu Rev Public Health. 2006; 27: 491-515
        • Cleave J.V.
        • Kuhlthau K.A.
        • Bloom S.
        • et al.
        Interventions to improve screening and follow-up in primary care: a systematic review of the evidence.
        Acad Pediatr. 2012; 12: 269-282
        • Winickoff J.P.
        • Nabi-Burza E.
        • Chang Y.
        • et al.
        Sustainability of a parental tobacco control intervention in pediatric practice.
        Pediatrics. 2014; 134: 933-941
        • Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents
        • National Heart, Lung, and Blood Institute
        Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: summary report.
        Pediatrics. 2011; 128: S213-S256
        • Rose G.L.
        • Ferraro T.A.
        • Skelly J.M.
        • et al.
        Feasibility of automated pre-screening for lifestyle and behavioral health risk factors in primary care.
        BMC Fam Pract. 2015; 16: 150
        • Loureiro M.L.
        • Nayga Jr, R.M.
        Obesity, weight loss, and physician's advice.
        Soc Sci Med. 2006; 62: 2458-2468
        • Anand V.
        • Carroll A.E.
        • Downs S.M.
        Automated primary care screening in pediatric waiting rooms.
        Pediatrics. 2012; 129: e1275-e1281
        • Bauer N.S.
        • Carroll A.E.
        • Downs S.M.
        Understanding the acceptability of a computer decision support system in pediatric primary care.
        J Am Med Inform Assoc. 2014; 21: 146-153
        • Anand V.
        • McKee S.
        • Dugan T.M.
        • et al.
        Leveraging electronic tablets for general pediatric care: a pilot study.
        Appl Clin Inform. 2015; 6: 1-15
        • Winickoff J.P.
        • Hipple B.
        • Drehmer J.
        • et al.
        The Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention: a decade of lessons learned.
        J Clin Outcomes Manag. 2012; 19: 414-419
        • Carroll A.E.
        • Bauer N.S.
        • Dugan T.M.
        • et al.
        Use of a computerized decision aid for developmental surveillance and screening: a randomized clinical trial.
        JAMA Pediatr. 2014; 168: 815-821
        • Dunlop A.L.
        • Leroy Z.
        • Trowbridge F.L.
        • et al.
        Improving providers' assessment and management of childhood overweight: results of an intervention.
        Ambul Pediatr. 2007; 7: 453-457
        • Ozer E.M.
        • Adams S.H.
        • Lustig J.L.
        • et al.
        Increasing the screening and counseling of adolescents for risky health behaviors: a primary care intervention.
        Pediatrics. 2005; 115: 960-968
        • Leone F.T.
        • Evers-Casey S.
        • Graden S.
        • et al.
        Behavioral economic insights into physician tobacco treatment decision-making.
        Ann Am Thorac Soc. 2015; 12: 364-369
        • Collins B.N.
        • Levin K.P.
        • Bryant-Stephens T.
        Pediatricians' practices and attitudes about environmental tobacco smoke and parental smoking.
        J Pediatr. 2007; 150: 547-552
        • Lowenstein L.M.
        • Perrin E.M.
        • Campbell M.K.
        • et al.
        Primary care providers' self-efficacy and outcome expectations for childhood obesity counseling.
        Child Obes. 2013; 9: 208-215
        • Halfon N.
        • Stevens G.D.
        • Larson K.
        • et al.
        Duration of a well-child visit: association with content, family-centeredness, and satisfaction.
        Pediatrics. 2011; 128: 657-664
        • Belamarich P.F.
        • Gandica R.
        • Stein R.E.
        • et al.
        Drowning in a sea of advice: pediatricians and American Academy of Pediatrics policy statements.
        Pediatrics. 2006; 118: e964-e978
        • Fisher-Owens S.A.
        • Amendola L.
        • Featherstone J.D.B.
        • et al.
        Increased public reimbursement for prophylactic visits with dentists associated with increased receipt of preventive dental services in children.
        J Public Health Dent. 2017; 77: 183-187
        • Scott A.
        • Sivey P.
        • Ait Ouakrim D.
        • et al.
        The effect of financial incentives on the quality of health care provided by primary care physicians.
        Cochrane Database Syst Rev. 2011; (CD008451)
        • Kenney G.M.
        • Marton J.
        • Klein A.E.
        • et al.
        The effects of Medicaid and CHIP policy changes on receipt of preventive care among children.
        Health Serv Res. 2011; 46: 298-318
        • Yoo B.K.
        • Berry A.
        • Kasajima M.
        • et al.
        Association between Medicaid reimbursement and child influenza vaccination rates.
        Pediatrics. 2010; 126: e998-e1010
        • Gleeson S.
        • Kelleher K.
        • Gardner W.
        Evaluating a pay-for-performance program for Medicaid children in an accountable care organization.
        JAMA Pediatr. 2016; 170: 259-266
        • Sciamanna C.N.
        • Goldstein M.G.
        • Marcus B.H.
        • et al.
        Accuracy of recall of exercise counseling among primary care patients.
        Prev Med. 2004; 39: 1063-1067