Caregiver and Clinician Perspectives on Missed Well-Child Visits

I commend Elizabeth R. Wolf and colleagues' recent publication, Caregiver and Clinician Perspectives on Missed Well-Child Visits, for reinforcing the value of well-child visits and highlighting the importance of addressing structural factors outside of the health care system which affect the health of vulnerable populations. In their paper, the authors present caregiver and clinician perspectives on missed well-child visits, focusing on the value of well-child visits, barriers to attendance, and facilitators of attendance. As the authors note, well-child visits are an important opportunity for clinicians and families to engage in health promoting behaviors (e.g., vaccinations) and discussions about disease prevention and management.(1) A substantial body of research suggests that identifying and treating disease in early childhood can have benefits across the life course.(2,3) Despite identifying similar benefits of well-child visits (e.g., providing immunizations and monitoring child growth and development), both caregivers and clinicians in this study reported that social stressors including transportation and childcare presented barriers to attendance. The authors offer broad recommendations to improve attendance, including providing transportation and childcare, implementing appointment reminders, and shifting toward value-based care as opposed to fee-for-service billing.(1)

While screening for social determinants of health would be a positive step toward improving health equity, screening alone may be insufficient. Buy-in from key stakeholders within and outside the health care system (e.g., social workers and community-based service organizations) is needed to connect caregivers and families to appropriate services and facilitate pediatric care coordination.(4) Working with stakeholders outside of the health care system to address structural and social barriers may help facilitate higher attendance rates. Additionally, it is worth nothing that race is not a risk factor for health care outcomes; rather, it is racial bias within our health care system which leads to disproportionate adverse health outcomes among marginalized populations and may deter caregivers from seeking medical care.(5) Although the authors report that they did not collect demographic data, these data may be important for identifying the potential role of racial bias in well-child attendance.

References

1. Wolf ER, O'Neil J, Pecsok J, et al. Caregiver and Clinician Perspectives on Missed Well-Child Visits. The Annals of Family Medicine. 2020;18(1):30-34.

2. Delaney L, Smith JP. Childhood health: trends and consequences over the life course. Future Child. 2012;22(1):43-63.

3. Thomas Boyce W, Hertzman C. Early Childhood Health and the Life Course: The State of the Science and Proposed Research Priorities. In: Halfon N, Forrest CB, Lerner RM, Faustman EM, eds. Handbook of Life Course Health Development. Cham: Springer International Publishing; 2018:61-93.

4. Andermann A. Screening for social determinants of health in clinical care: moving from the margins to the mainstream. Public Health Rev. 2018;39:19-19.

5. Williams DR, Wyatt R. Racial Bias in Health Care and Health: Challenges and Opportunities. JAMA. 2015;314(6):555-556.

Competing interests: None declared