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How Do Family Physicians Provide Anticipatory Guidance during Well-Child Visits?

From Family and Community Medicine, Texas Tech University Health Sciences Center, Amarillo, TX 79106 (RY); and Mercer University School of Medicine, Macon, GA 31207 (JB)

Correspondence: Corresponding author: Dr. Rodney Young, Family and Community Medicine, Texas Tech University Health Sciences Center, 1400 S. Coulter, Suite 2700, Amarillo, TX 79106

Introduction: Anticipatory guidance is an important part of well-child care, yet little is known about the way family physicians provide this guidance. This study describes the methods that family physicians use to provide anticipatory guidance during well-child visits.

Methods: A questionnaire was mailed to 1000 family physicians. Respondents rated 6 anticipatory guidance methods on frequency of use. The questionnaire addressed method of documentation, use of forms or guidance prompts, visit frequency for total, well-child, and other pediatric visits, and demographic information; t tests and ANOVA were applied (P < .05 significant).

Results: There were 495 questionnaires returned for a response rate of 49.5%. Respondents were more likely to provide anticipatory guidance verbally than by handout (Likert scale where 1 = never and 9 = always, mean 7.8 vs 4.2, P < .0001). Physicians using well visit forms more commonly initiate guidance discussions (7.6 vs 6.8, P = .0002), address concerns (8.2 vs 7.5, P = .0001), and provide handouts (4.3 vs 3.3, P = .0002). Physicians in academic or multispecialty practices used handouts more often than private practitioners (5.0 vs 3.6, P = .0003, 5.1 vs 3.6, P = .0002, respectively) as did those with 7 well-child visits per week compared with <7 visits per week (4.8 vs 3.8, P = .0028).

Conclusions: Family physicians primarily provide anticipatory guidance verbally. Use of well visit forms or other prompts are associated with better provision of anticipatory guidance.