Applications of health care research to child health services: a problematic relationship.

The direct impact of community health surveys on clinical practice is, essentially, unknown. The importance of behavioral problems as an unmet child health need was demonstrated by studies in the Isle of Wight (UK) and Rochester, New York (USA). Follow-up reports suggest persistently inadequate recognition of such problems by samples of practitioners in these two places. Several American centers have evaluated the training and use of pediatric nurse practitioners in response to a perceived shortage of personnel and maldistribution of primary care for children. A comparison of surveys of American pediatric practices before and after these reports reveals persistent shortcomings in the degree of delegation of tasks to auxiliary personnel. General strategies to improve the responses of primary care practitioners to survey research findings are discussed, with particular emphasis on the role of the individual investigator.