Published online June 1, 2006
PEDIATRICS Vol. 117 No. 6 June 2006, pp. e1233-e1236 (doi:10.1542/peds.2005-1826)
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SPECIAL ARTICLE

Thoughts on Health Supervision: Learning-Focused Primary Care

Robert Needlman, MD

Department of Pediatrics, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio

Primary care clinicians confront a long list of topics that are supposed to be covered during well-child visits, but evidence for the effectiveness of preventive counseling for most issues is limited, and it is doubtful that covering more topics confers correspondingly enhanced clinical benefits. Amid growing professional interest in rethinking primary care, 3 ideas that would facilitate constructive change are proposed. First, face-to-face time between doctors and parents should be allocated as a scarce resource, with priority given to topics that are both important and uniquely responsive to in-office intervention. Second, to maximize the educational value of anticipatory guidance, visits could focus on experiential, as opposed to merely didactic, learning. Finally, recommendations for primary care should be based on evidence, rather than expert opinion. Competing protocols for preventive care ought to be subjected to large-scale, coordinated research. The unit of analysis should be the visit or series of visits, rather than a single intervention. A crucial first step would be the definition of universal outcome measures.

Key Words: anticipatory guidance • primary care • preventive services • preventive health care visits • learning

Abbreviations: AAP—American Academy of Pediatrics • NBAS—Newborn Behavioral Assessment Scale

Accepted Dec 21, 2005.