Biomaterial Database

Unanswered questions prompted during pediatric primary care visits. 2007

Chuck Norlin, and Adam L Sharp, and Sean D Firth

Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA. chuck.norlin@hsc.utah.edu

OBJECTIVE To identify the frequency, types, and perceived importance of questions prompted during primary care visits for which pediatricians have no ready answer; to characterize pediatricians' responses to them; and to determine how questions prompted while caring for children with special health care needs (CSHCN) and children without special needs (Cw/oSN) differ. METHODS Patient visits with 35 general pediatricians were observed. Parents completed a CSHCN screener. Physicians provided details about their unanswered questions and their pursuit of answers. RESULTS Of 890 observed visits, 170 (19.1%) prompted unanswered questions, of which 60.1% were deemed important or very important. Physicians intended to pursue answers to 49.7% of the questions but actually pursued answers for only 27.5%, citing lack of time and inadequate information resources as barriers. One hundred sixty-seven (18.8%) visits were with CSHCN. Unanswered questions arose more often with CSHCN than with Cw/oSN (28.7% vs 16.9%; odds ratio 1.98; 95% confidence interval, 1.32-2.97), particularly during well visits (34.6% vs 14.9%; odds ratio 3.24; 95% confidence interval, 1.59-6.39). CSHCN prompted more diagnosis and treatment questions than Cw/oSN. Questions prompted by CSHCN were ranked as more important but were no more likely to be pursued than those prompted by Cw/oSN. CONCLUSIONS Unanswered questions arise during nearly 20% of pediatric primary care visits. Visits with CSHCN, particularly well visits, generate more questions than those with Cw/oSN. Answers are pursued for few unanswered questions, both overall and for CSHCN. Potential strategies to overcome barriers to answering questions include scheduling more time or more visits for CSHCN.

UI	MeSH Term	Description	Entries
D009819	Office Visits	Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up.	Office Visit,Visit, Office,Visits, Office
D010353	Patient Education as Topic	The teaching or training of patients concerning their own health needs.	Education of Patients,Education, Patient,Patient Education
D010372	Pediatrics	A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence.
D010817	Physician-Patient Relations	The interactions between physician and patient.	Doctor-Patient Relations,Doctor Patient Relations,Physician Patient Relations,Physician Patient Relationship,Doctor Patient Relation,Doctor-Patient Relation,Physician Patient Relation,Physician Patient Relationships,Physician-Patient Relation,Relation, Doctor Patient,Relation, Doctor-Patient,Relation, Physician Patient,Relation, Physician-Patient,Relations, Doctor Patient,Relations, Doctor-Patient,Relations, Physician Patient,Relations, Physician-Patient,Relationship, Physician Patient,Relationships, Physician Patient
D011320	Primary Health Care	Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192)	Primary Care,Primary Healthcare,Care, Primary,Care, Primary Health,Health Care, Primary,Healthcare, Primary
D011368	Professional-Family Relations	The interactions between the professional person and the family.	Professional Family Relationship,Family Relationship, Professional,Family Relationships, Professional,Professional Family Relations,Professional Family Relationships,Professional-Family Relation,Relation, Professional-Family,Relations, Professional-Family,Relationship, Professional Family,Relationships, Professional Family
D002648	Child	A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL.	Children
D002983	Clinical Competence	The capability to perform acceptably those duties directly related to patient care.	Clinical Skills,Competence, Clinical,Clinical Competency,Clinical Skill,Competency, Clinical,Skill, Clinical,Skills, Clinical,Clinical Competencies,Competencies, Clinical
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328	Adult	A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available.	Adults