How much time is spent on well-child care and vaccinations?

Context: Because well-child care represents the most important prevention o pportunity in the health care system, a growing number of activities and in dicators have been proposed for it. Objective: To measure the time spent in the various components of well-chil d care. Design: Time-and-motion study. Setting Five private pediatric practices and 2 public providers in Rocheste r, NY. Participants: One hundred sixty-four children younger than 2 years. Main Outcome Measure: Duration of family's encounters with the primary care provider (physician or nurse practitioner), nurse, and other personnel. Results: The median encounter times and their component parts in minutes we re: (1) primary care provider, 16.3 (physical examination, 4.9; vaccination discussion, 1.9; discussion of other health issues, 9.5; vaccination admin istration, 0); (2) nurse, 5.6 (physical examination, 3.5; vaccination discu ssion, 0; other health discussion, 0; vaccine administration, 1.6); and (3) other personnel, 0 for all categories. Public provider setting, African Am erican race of the child, and administration of 4 vaccinations were signifi cantly associated with an increase (3-4 minutes) in the duration of the pri mary care provider encounter. Only 8 (5%) of families read vaccine informat ion materials. Conclusions: Depending on whether a child makes the usual 3 or recommended 6 number of well-child visits, the total time of well-child care is 45 to 9 0 minutes during the first year of life and declines to less than 30 minute s per year thereafter as the number of recommended visits diminish. Because high-risk children make half as many well-child care visits as other child ren, a 3 to 4 minute increase in encounter time is insufficient to provide them with the same level of care as other children.