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How much time is spent on well-child care and vaccinations?

CONTEXT
Because well-child care represents the most important prevention opportunity in the health care system, a growing number of activities and indicators have been proposed for it.


OBJECTIVE
To measure the time spent in the various components of well-child care.


DESIGN
Time-and-motion study.


SETTING
Five private pediatric practices and 2 public providers in Rochester, NY.


PARTICIPANTS
One hundred sixty-four children younger than 2 years.


MAIN OUTCOME MEASURE
Duration of family's encounters with the primary care provider (physician or nurse practitioner), nurse, and other personnel.


RESULTS
The median encounter times and their component parts in minutes were: (1) primary care provider, 16.3 (physical examination, 4.9; vaccination discussion, 1.9; discussion of other health issues, 9.5; vaccination administration, 0); (2) nurse, 5.6 (physical examination, 3.5; vaccination discussion, 0; other health discussion, 0; vaccine administration, 1.6); and (3) other personnel, 0 for all categories. Public provider setting, African American race of the child, and administration of 4 vaccinations were significantly associated with an increase (3-4 minutes) in the duration of the primary care provider encounter. Only 8 (5%) of families read vaccine information materials.


CONCLUSIONS
Depending on whether a child makes the usual 3 or recommended 6 number of well-child visits, the total time of well-child care is 45 to 90 minutes during the first year of life and declines to less than 30 minutes per year thereafter as the number of recommended visits diminish. Because high-risk children make half as many well-child care visits as other children, a 3 to 4 minute increase in encounter time is insufficient to provide them with the same level of care as other children.