Rates of detection of developmental problems at the 18-month well-baby visit by family physicians' using four
R E Thomas1, W Spragins2, G Mazloum3
1Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
Insights
Evidence-based developmental screening tools significantly improve early identification of developmental problems in children compared to usual care. However, referral rates remained similar, suggesting a need for better clinician support and training for effective intervention.
Area of Science:
- Pediatrics
- Developmental Psychology
- Health Services Research
Background:
- Early developmental screening is crucial for timely intervention but is underutilized.
- Developmental issues are often apparent by the 18-month well-baby visit.
- Current screening practices may not be sufficiently evidence-based.
Purpose of the Study:
- To compare the effectiveness of evidence-based screening tools versus non-evidence-based methods in identifying developmental problems.
- To assess the feasibility of completing four validated screening tools within a 10-minute pre-visit timeframe on a computer.
Main Methods:
- A randomized trial involving 54 families compared 'usual care' (informal judgment) with 'evidence-based care' (using PEDS, PEDS-DM, M-CHAT, PHQ9).
- Families were assigned to either usual care (n=25) or evidence-based care (n=29).
- Screening tools were administered online prior to the well-baby visit.
Main Results:
- The evidence-based group identified 62% (18/29) with possible developmental problems, versus 16% (4/25) in the usual care group.
- All online forms were completed within the 10-minute target.
- Referral rates did not differ significantly between the groups despite higher detection in the evidence-based group.
Conclusions:
- Evidence-based tools significantly increase the detection rate of developmental problems.
- Clinician judgment may override screening results, or there may be a need for improved understanding and referral support.
- Enhancing clinician training, practice support, and regional health authority involvement could improve the screening and referral process.
Background:
Early and regular developmental screening can improve children's development through early intervention but is insufficiently used. Most developmental problems are readily evident at the 18-month well-baby visit. This trial's purpose is to: (1) compare identification rates of developmental problems by GPs/family physicians using four evidence-based tools with non-evidence based screening, and (2) ascertain whether the four tools can be completed in 10-min pre-visit on a computer.
Methods:
We compared two approaches to early identification via random assignment of 54 families to either: 'usual care' (informal judgment including ad-hoc milestones, n = 25); or (2) 'Evidence-based' care (use of four validated, accurate screening tools, n = 29), including: the Parents' Evaluation of Developmental Status (PEDS), the PEDS-Developmental Milestones (PEDS-DM), the Modified Checklist for Autism in Toddlers (M-CHAT) and PHQ9 (maternal depression).
Results:
In the 'usual care' group four (16%) and in the evidence-based tools group 18 (62%) were identified as having a possible developmental problem. In the evidence-based tools group three infants were to be recalled at 24 months for language checks (no specialist referrals made). In the 'usual care' group four problems were identified: one child was referred for speech therapy, two to return to check language at 24 months and a mother to discuss depression. All forms were completed on-line within 10 min.
Conclusions:
Despite higher early detection rates in the evidence-based care group, there were no differences in referral rates between evidence-based and usual-care groups. This suggests that clinicians: (1) override evidence-based screening results with informal judgment; and/or (2) need assistance understanding test results and making referrals. Possible solutions are improve the quality of information obtained from the screening process, improved training of physicians, improved support for individual practices and acceptance by the regional health authority for overall responsibility for screening and creation of a comprehensive network.
