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Quality of Care

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Parents can play an important part in developing and disseminating pediatric practice guidelines

Parents are high stakeholders in children's health and are in a good position to influence their doctors to adopt pediatric clinical practice guidelines. For that to happen, parents must be brought into the loop during guideline development, note Howard Bauchner, M.D., Professor of Pediatrics and Director of the Division of General Pediatrics at Boston University School of Medicine, and Lisa Simpson, M.B., B.Ch., Deputy Administrator of the Agency for Health Care Policy and Research.

Drs. Bauchner and Simpson reviewed the status of pediatric practice guidelines and examined key issues that may limit guideline effectiveness in improving quality of care for children. They point to a recent survey of U.S. pediatricians which showed that 35 percent of the physicians surveyed regularly use guidelines, 44 percent sometimes use them, and 21 percent never use guidelines. Few groups have incorporated family preferences in the development of pediatric practice guidelines. Some studies have shown that parents and physicians have fundamental value differences with respect to diagnostic testing, diagnostic error, and medical risk. If development of pediatric guidelines continues with minimal input from parents, they may not be relevant and will fail to improve the quality and appropriateness of pediatric care, according to the authors.

They suggest that guidelines be written so that parents can understand them and that the guidelines be made available to parents in physicians' offices; over the Internet; to parent groups for specific medical problems, such as attention deficit hyperactivity disorder; and in magazines aimed at parents. Targeting parents as agents of change, through the print and electronic media, may help to increase guideline acceptance and adoption, conclude the authors.

See "Specific issues related to developing, disseminating, and implementing pediatric practice guidelines for physicians, patients, families, and other stakeholders," by Drs. Bauchner and Simpson, in the October 1998 Health Services Research 33(4), pp. 1161-1177.

Reprints (AHCPR Publication No. 99-R003) are available from the AHCPR Publications Clearinghouse.

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