Published online January 3, 2005
PEDIATRICS Vol. 115 No. 1 January 2005, pp. 48-56 (doi:10.1542/peds.2004-1193)
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Medical Homes for At-Risk Children: Parental Reports of Clinician-Parent Relationships, Anticipatory Guidance, and Behavior Changes

Catherine S. Nelson, MD, MPH*, Susan M. Higman, PhD*, Calvin Sia, MD{ddagger}, Elizabeth McFarlane, MPH*, Loretta Fuddy, LCSW, MPH§ and Anne K. Duggan, ScD*

* Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
{ddagger} Department of Pediatrics, University of Hawaii John Burns School of Medicine, Honolulu, Hawaii
§ Hawaii State Department of Health, Honolulu, Hawaii

Background. Family-centeredness, compassion, and trust are 3 attributes of the clinician-parent relationship in the medical home. Among adults, these attributes are associated with patients' adherence to clinicians' advice.

Objectives. The objectives were (1) to measure medical home attributes related to the clinician-parent relationship, (2) to measure provision of anticipatory guidance regarding injury and illness prevention, (3) to relate anticipatory guidance to parental behavior changes, and (4) to relate medical home attributes to anticipatory guidance and parental behavior changes.

Methods. A cross-sectional study of data collected among at-risk families when children were 1 year of age, in a randomized, controlled trial of a home-visiting program to prevent child abuse and neglect, was performed. Modified subscales of the Primary Care Assessment Survey were used to measure parental ratings of clinicians' family-centeredness, compassion, and trust. Parental reports of provision of anticipatory guidance regarding injury and illness prevention topics (smoke alarms, infant walkers, car seats, hot water temperature, stair guards, sunscreen, firearm safety, and bottle propping) and behavior changes were recorded.

Results. Of the 564 mothers interviewed when their children were 1 year of age, 402 (71%) had a primary care provider and had complete data for anticipatory guidance items. By definition, poverty, partner violence, poor maternal mental health, and maternal substance abuse were common in the study sample. Maternal ratings of clinicians' family-centeredness, compassion, and trust were fairly high but ranged widely and varied among population subgroups. Families reported anticipatory guidance for a mean of 4.6 ± 2.2 topics relevant for discussion. Each medical home attribute was positively associated with parental reports of completeness of anticipatory guidance, ie, family-centeredness (ß = .026, SE = .004), compassion (ß = .019, SE = .005), and trust (ß = .016, SE = .005). Parents' perceptions of behavior changes were positively associated with trust (ß = .018, SE = .006). Analyses were adjusted for potential confounding by randomized, controlled trial group assignment, receipt of ≥5 well-child visits, and baseline attributes.

Conclusions. Among at-risk families, we found an association between parental ratings of the medical home and parental reports of the completeness of anticipatory guidance regarding selected injury and illness prevention topics. Parents' trust of the clinician was associated with parent-reported behavior changes for discussed topics.

Key Words: medical home • anticipatory guidance • behavior changes • clinician-parent relationship • family-centered • compassion • trust • at-risk families

Abbreviations: AAP, American Academy of Pediatrics • RCT, randomized, controlled trial • HSP, Healthy Start Program • WCV, well-child visit • PCAS, Primary Care Assessment Survey

Accepted Jun 7, 2004.




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