Fenick Ada M, Leventhal John M, Gilliam Walter, Rosenthal Marjorie S
Yale University, New Haven, CT, USA.
Clin Pediatr (Phila). 2020 Jun;59(7):686-691. doi: 10.1177/0009922820908582. Epub 2020 Feb 28.
Well-child care has suboptimal outcomes regarding adherence to appointments and recall of guidance, especially among families facing structural barriers to health. Group well-child care (GWCC) aims to improve these outcomes by enhancing anticipatory guidance discussions and peer education. We conducted a randomized controlled trial, comparing GWCC with traditional, individual well-child care (IWCC) and assessed health care utilization, immunization timeliness, recall of anticipatory guidance, and family-centered care. Ninety-seven mother-infant dyads were randomized to GWCC or IWCC. Compared with IWCC infants, GWCC infants attended more of the 6 preventive health visits (5.41 vs 4.87, < .05) and received more timely immunization at 6 months and 1 year but did not differ in emergency or hospital admission rates. There were no differences in mothers' reports of anticipatory guidance received or family-centered care. As primary care is redesigned for value-based care and structural vulnerabilities are considered, GWCC may be a key option to consider.
在预约就诊的依从性和指导内容的记忆方面，健康儿童保健的效果欠佳，尤其是在面临健康方面结构障碍的家庭中。集体健康儿童保健（GWCC）旨在通过加强预期指导讨论和同伴教育来改善这些结果。我们进行了一项随机对照试验，将GWCC与传统的个体健康儿童保健（IWCC）进行比较，并评估了医疗保健利用率、免疫接种及时性、预期指导的记忆以及以家庭为中心的护理。97对母婴二元组被随机分配到GWCC或IWCC组。与IWCC组的婴儿相比，GWCC组的婴儿参加了更多的6次预防性健康检查（5.41次对4.87次，P<0.05），并在6个月和1岁时接受了更及时的免疫接种，但在急诊或住院率方面没有差异。母亲报告的所接受的预期指导或家庭为中心的护理方面没有差异。随着初级保健为基于价值的护理进行重新设计并考虑到结构脆弱性，GWCC可能是一个值得考虑的关键选择。
