September 1978
524
TheJourna/ojPEDIATRICS
The use of developmental screening tests by primary-care pediatricians Two-hundred-twenty-two pediatricians were surveyed to determine the lise oj developmental screening tests in primary-care pediatrics. Sixty-three percent oj the 121 primary care pediatricians responding 10 this survey reported tnai they use developmental screening tests, but only 15 to 20% screen more than 1fHooj theirpatients with these tests. Factors associated with the lise of developmental screening tests included the year of graduation from medicalschool, level of postinternshlp training, duration oj current practice, training in the use oj tests as a house officer Orfellow or at postgraduate seminars. and belief that the use of developmental screening is a necessary part of routine health maintenance. Pediatricians use developmental screening tests infrequently and. probably, only after evidence oj developmental delay has been established by other criteria.
Richard D. Smith, M.D., Salt Lake City, Utah
To OBTAIN INFORM A nON regarding the use of developmental screening tests by American primary-care pediatricians, the graduates of a major southwestern medical school, who are now practicing pediatrics. were surveyed. METHODS A computer printout of 1940-1972 University of Texas Medical Branch graduates was reviewed. Of the physicians in this sample, the 222 known by self-report to be in pediatrics were the subjects of this study. A self-administered mailed questionnaire sought information on the respondents' current developmental screening practices, their training, patient and practice characteristics, and their opinions of the value of developmental screening tests. The survey questionnaire was pretested to improve its clarity and comprehension. An explanatory letter and questionnaire were mailed to all pediatricians in the study population. A second explanatory letter and questionnaire were mailed six weeks later to all pediatricians not responding to the /irst mailing; those pediatricians not responding to the second mailing were contacted by telephone. An attempt was made to complete the quesReprint address: School Health Programs, Child Health Center, C62. University of Texas Medical Branch. Galveston.
TX 77550.
Vol. 93, No.3. pp. 524-527
tionnaire during this telephone contact. Respondents unable to complete the questionnaire during the telephone contact were requested to complete and return the questionnaire at their earliest convenience. Data from all pediatricians in primary-care practices were analyzed. Subject responses were double-coded and transferred to data processing cards. The Statistical Package for the Social Sciences program' was used to calculate the number (percentage) of respondents who reported utilization of developmental screening tests and the percentage of well children, between birth and 6 years of age, whom they screened using these tests. Cross-tabulations were then generated to analyze. the relationships between the use of developmental screening tests and pediatricians' training their practice situations, and the volume and nature of patient visits. The chi-square test' was used to determine the significance of these relationships at the 0.05 level.
RESULTS Response patterns. One-hundred-seventy-six (80%) of the 222 pediatricians responded to the mailed questionnaire. Fifty-five of the respondents were engaged in subspecialty or other types of practice or in academic settings and did not have primary-care responsibilities. The remaining 121 (69%) were in primary-care practices. Eighty-one (67%) of the 121 primary-care pediatricians responded before the telephone contact: 40 (33%) re-
0022-3476J78/0393·0524$OOAOIO e 1978 The C. V. Mosby Co.
Vallone 93 Number 3
sponded after the telephone contact. Nonrespondent pediatricians (46) did not differ from primary-care respondents (i21) when compared on year of graduation from medical school, number of years of postinternship training, and size of the practice communities. Training and practice characteristics. It was anticipated that respondents' training and practice characteristics would be related to the use of developmental screening tests. Seventy percent of the respondents graduated from medical school before 1965. Ninety-seven percent reported that they had completed two or more years of postinternship pediatric training; 60% reported that they are Board certified. Eighty percent of the respondents are in private practices; 42% have been in their current practice for less than ten years. Seventy-seven percent reported seeing 20 to 40 patients daily; 17% see more than 40 patients. Seventy-five percent of the respondents performed six to 20 well-child examinations daily on children less than 6 years of age. For 60% of the respondents a typical well-child visit lasts 10 to 20 minutes; for 27% this visit lasts five to ten minutes. Ancillary medical personnel available in the respondents' practice settings included : RN/LPNs (88%); health aides (35%); nurse practitioners (18%); and physician assistants (9%). A comparison of these characteristics with previous studies of primary-care pediatrics" , reveals a number of similarities. These include the percentage of respondents who have completed the core years of pediatric training, the percentage who are Board certified, and the percentage in private practice. Other areas of similarity are the total number of patients seen daily, the number and duration of daily well-child visits, and the number and type of ancillary medical personnel in the practice setting. Use of parental recall of developmental milestones and "clinical assessment of development." The Figure shows the percentage of respondents who employ any screening technique on all children presenting for weIl-child care in any of six age groups between birth and 6 years . Onehundred-and-sixteen (95.6%) respondents reported that they rely on the parents' recall of developmental milestones as a developmental screening technique. Onehundred-and-eighteen (97.5%) perform a "clinical assessment of development" by utilizing informal techniques during the routine physical examination to appraise an infant's/child's developmental level. Use of developmental screening tests. Sixty-three respondents (52%) reported that they utilize standardized developmental screening tests in which written records are kept. Fifty-eight (48%) use the Denver Developmental Screening Test. Twelve (10%) utilize other tests including the Peabody Picture Vocabulary Test,' the Draw-A-
Use of developmental screening tests
525
r:
:E'"
:c u
524
TheJourna/ojPEDIATRICS
The use of developmental screening tests by primary-care pediatricians Two-hundred-twenty-two pediatricians were surveyed to determine the lise oj developmental screening tests in primary-care pediatrics. Sixty-three percent oj the 121 primary care pediatricians responding 10 this survey reported tnai they use developmental screening tests, but only 15 to 20% screen more than 1fHooj theirpatients with these tests. Factors associated with the lise of developmental screening tests included the year of graduation from medicalschool, level of postinternshlp training, duration oj current practice, training in the use oj tests as a house officer Orfellow or at postgraduate seminars. and belief that the use of developmental screening is a necessary part of routine health maintenance. Pediatricians use developmental screening tests infrequently and. probably, only after evidence oj developmental delay has been established by other criteria.
Richard D. Smith, M.D., Salt Lake City, Utah
To OBTAIN INFORM A nON regarding the use of developmental screening tests by American primary-care pediatricians, the graduates of a major southwestern medical school, who are now practicing pediatrics. were surveyed. METHODS A computer printout of 1940-1972 University of Texas Medical Branch graduates was reviewed. Of the physicians in this sample, the 222 known by self-report to be in pediatrics were the subjects of this study. A self-administered mailed questionnaire sought information on the respondents' current developmental screening practices, their training, patient and practice characteristics, and their opinions of the value of developmental screening tests. The survey questionnaire was pretested to improve its clarity and comprehension. An explanatory letter and questionnaire were mailed to all pediatricians in the study population. A second explanatory letter and questionnaire were mailed six weeks later to all pediatricians not responding to the /irst mailing; those pediatricians not responding to the second mailing were contacted by telephone. An attempt was made to complete the quesReprint address: School Health Programs, Child Health Center, C62. University of Texas Medical Branch. Galveston.
TX 77550.
Vol. 93, No.3. pp. 524-527
tionnaire during this telephone contact. Respondents unable to complete the questionnaire during the telephone contact were requested to complete and return the questionnaire at their earliest convenience. Data from all pediatricians in primary-care practices were analyzed. Subject responses were double-coded and transferred to data processing cards. The Statistical Package for the Social Sciences program' was used to calculate the number (percentage) of respondents who reported utilization of developmental screening tests and the percentage of well children, between birth and 6 years of age, whom they screened using these tests. Cross-tabulations were then generated to analyze. the relationships between the use of developmental screening tests and pediatricians' training their practice situations, and the volume and nature of patient visits. The chi-square test' was used to determine the significance of these relationships at the 0.05 level.
RESULTS Response patterns. One-hundred-seventy-six (80%) of the 222 pediatricians responded to the mailed questionnaire. Fifty-five of the respondents were engaged in subspecialty or other types of practice or in academic settings and did not have primary-care responsibilities. The remaining 121 (69%) were in primary-care practices. Eighty-one (67%) of the 121 primary-care pediatricians responded before the telephone contact: 40 (33%) re-
0022-3476J78/0393·0524$OOAOIO e 1978 The C. V. Mosby Co.
Vallone 93 Number 3
sponded after the telephone contact. Nonrespondent pediatricians (46) did not differ from primary-care respondents (i21) when compared on year of graduation from medical school, number of years of postinternship training, and size of the practice communities. Training and practice characteristics. It was anticipated that respondents' training and practice characteristics would be related to the use of developmental screening tests. Seventy percent of the respondents graduated from medical school before 1965. Ninety-seven percent reported that they had completed two or more years of postinternship pediatric training; 60% reported that they are Board certified. Eighty percent of the respondents are in private practices; 42% have been in their current practice for less than ten years. Seventy-seven percent reported seeing 20 to 40 patients daily; 17% see more than 40 patients. Seventy-five percent of the respondents performed six to 20 well-child examinations daily on children less than 6 years of age. For 60% of the respondents a typical well-child visit lasts 10 to 20 minutes; for 27% this visit lasts five to ten minutes. Ancillary medical personnel available in the respondents' practice settings included : RN/LPNs (88%); health aides (35%); nurse practitioners (18%); and physician assistants (9%). A comparison of these characteristics with previous studies of primary-care pediatrics" , reveals a number of similarities. These include the percentage of respondents who have completed the core years of pediatric training, the percentage who are Board certified, and the percentage in private practice. Other areas of similarity are the total number of patients seen daily, the number and duration of daily well-child visits, and the number and type of ancillary medical personnel in the practice setting. Use of parental recall of developmental milestones and "clinical assessment of development." The Figure shows the percentage of respondents who employ any screening technique on all children presenting for weIl-child care in any of six age groups between birth and 6 years . Onehundred-and-sixteen (95.6%) respondents reported that they rely on the parents' recall of developmental milestones as a developmental screening technique. Onehundred-and-eighteen (97.5%) perform a "clinical assessment of development" by utilizing informal techniques during the routine physical examination to appraise an infant's/child's developmental level. Use of developmental screening tests. Sixty-three respondents (52%) reported that they utilize standardized developmental screening tests in which written records are kept. Fifty-eight (48%) use the Denver Developmental Screening Test. Twelve (10%) utilize other tests including the Peabody Picture Vocabulary Test,' the Draw-A-
Use of developmental screening tests
525
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