Making sure caregivers understand diagnosis important for pediatricians
By Graciela Gutierrez
More needs to be done to make sure a child's health care doesn't end when he or she leaves the exam room, according to researchers at Baylor College of Medicine after reviewing a survey on pediatricians' view of caregivers' medical understanding.
The results of the survey were presented by Michael Speer, M.D., lead author of the study, professor of pediatrics - neonatology at BCM and medical director of the neonatal nurse practitioner program at Texas Children's Hospital, on May 5 at the Annual Meeting of the Pediatric Academic Societies in Honolulu.
Poor outcome possible
"If a parent or guardian doesn't understand the medication dosages, how to administer the medicine, or even the importance of getting to the next doctor's appointment, it could lead to a poor outcome for the child's recovery," said Speer, who is also medical director of nurseries at both St. Luke's Episcopal Hospital and The Methodist Hospital.
The Academy of Pediatrics randomly selected 1,605 pediatricians of all specialties to receive the 91-question survey. Of that group, 848 responded; of those, there were 669 that could be divided into publicly-funded or private insurance coverage.
"This survey looked at how physicians view their own practice," Speer said. "We're hoping for physicians and their offices to realize they can do better in assessing whether or not the caregivers understand how to take care of the child after the visit."
The questions covered topics such as the caregivers' perceived cognitive skills as well as proficiency in English.
Physicians aware of issues
Doctors also were asked questions about whether they were aware of the caregiver's problems in understanding the material. Seventy-eight percent of physicians who treat patients where more than 50 percent are covered by private insurance (less than half are covered with public insurance) answered yes, they were aware that caregivers did not understand the medical information given to them. Eighty-four percent of physicians who treat patients where less than 50 percent are covered by private insurance (more than half covered by public insurance) answered yes as well.
"In both areas, doctors perceive a problem with caregivers' understanding the medical instructions given to them," said Speer. "The results show us that something needs to be done in the physician's office. Even small changes can make a difference in the outcome of a child's health."
Small changes
Some of those changes are as simple as rewording a question. Rather than a doctor or nurse asking the caregiver if he or she understands the instructions given, the physician might say instead, "What can I go over with you again? The material can be confusing."
Another method is called teach-back. Once the physician or nurse has explained the medical procedures needed for further treatment out of the office, the caregiver is then asked to repeat or re-teach the information to the doctor.
Right now there is no study comparing these results to statistics that show the outcome of patients who are injured or their illness worsened because of misunderstanding of the medical information.
"It is our theory that if caregivers understand the importance of continued treatment or proper medication dosages, then the patients would have a better outcome," Speer said.
Other researchers who took part in the study include Teri Turner, Perri Klass, Mary Ann Abrams, Benard Dreyer, Modena Wilson, William Cull. Respectively, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; New York University School of Medicine, New York, NY; Blank Children's Hospital, Iowa Health System, Des Moines, Iowa; New York University School of Medicine, NY; American Medical Association, Chicago, Ill.; American Academy of Pediatrics, Elk Grove Village, Ill.
The study was funded by the American Academy of Pediatrics.
