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Predicting clinician injury prevention counseling for young children
1Department of Health Services, University of California-Los Angeles, USA. sbarkin@wfubmc.edu
Insights
Pediatric clinicians frequently discuss motor vehicle and toxic ingestion prevention but less often cover drowning and firearm injuries. Standardized programs may improve injury prevention counseling during well-child visits.
Area of Science:
- Pediatric medicine
- Public health
- Injury prevention
Background:
- Childhood injury is a leading cause of morbidity and mortality.
- Effective counseling during well-child examinations is crucial for injury prevention.
Purpose of the Study:
- To document clinicians' reported counseling behaviors regarding four key injury prevention topics.
- To identify factors influencing counseling on motor vehicle crashes, toxic ingestion, drowning, and firearm injuries in young children.
Main Methods:
- A mailed questionnaire survey was distributed to 465 pediatricians, family physicians, and pediatric nurse practitioners.
- Multivariate logistic regression analysis was used to predict counseling behaviors based on various factors.
Main Results:
- While motor vehicle occupant protection (66.2%) and toxic ingestion prevention (62.1%) were commonly discussed, drowning (31.8%) and firearm injury (15.7%) prevention were less frequent.
- Female clinicians and those in Health Maintenance Organization (HMO) settings were more likely to provide counseling.
- Clinicians who placed lower importance on counseling were less likely to discuss drowning and firearm injuries.
Conclusions:
- Clinicians' knowledge of injury epidemiology did not correlate with their counseling practices.
- Implementing standardized programs, like The Injury Prevention Program, could enhance consistent injury prevention counseling during well-child visits.
Background:
Injury is the primary cause of morbidity and mortality in children and an important topic for counseling.
Objective:
To describe and explain clinicians' reported counseling behavior during the well-child examinations for children aged 5 years and younger on the following 4 injury prevention topics: motor vehicle crashes, toxic ingestion, drowning, and firearm injuries.
Methods:
A random sample of 465 pediatricians, family physicians, and pediatric nurse practitioners in an urban setting received mailed questionnaires; 325 (69.9%) responded. Multivariate logistic regression predicting counseling on each injury prevention topic was performed.
Results:
Most reported discussing motor vehicle occupant protection (66.2%) and toxic ingestion prevention (62.1%) during the well-child examination. Only 31.8% stated they counseled on drowning prevention and 15.7%, on firearm injury prevention. Knowledge of injury mortality and morbidity rates was not associated with counseling. For most topics, female respondents were more likely to counsel than male respondents (motor vehicle crash odds ratio [OR], 2.24 [P = .03]; toxic ingestion OR, 1.82 [P = .05]; drowning OR, 1.97 [P = .04]). Health maintenance organization settings predicted injury prevention counseling for most topics (motor vehicle crash OR, 2.52 [P = .04]; toxic ingestion OR, 2.77 [P = .01]; firearm injury OR, 2.97 [P = .001]). Clinicians placing lower importance on counseling were less likely to counsel on drowning and firearm injury (drowning OR, 0.73 [P = .006]; firearm injury OR, 0.58 [P<.001]).
Conclusions:
Clinicians' knowledge of local injury epidemiology did not influence their counseling on these topics. Clinicians and their patients might benefit by using programs such as The Injury Prevention Program to help them standardize their approach to injury prevention counseling during the routine well-child examination.