Drowning in a sea of advice: Pediatricians and American Academy of Pediatrics policy statements
Drowning in a sea of advice: Pediatricians and American Academy of Pediatrics policy statements
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DOI：
10.1542/peds.2006-0652
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发表时间：
2006-10-01
期刊：
影响因子：
8
通讯作者：
Racine, Andrew D.
中科院分区：
文献类型：
--
作者：
Belamarich, Peter F.;Gandica, Rachelle;Racine, Andrew D.
目标。美国儿科学会（American Academy of Pediatrics）政策声明的激增，给儿科医生提供了越来越多的健康建议，但在文献中没有对儿科健康建议期望的定量估计。本研究的目的是量化和描述儿科医生期望向患者/监护人提供的口头健康建议。作者阅读并编码了344份美国儿科学会的政策声明，这些政策声明包含在美国儿科学会的儿科临床实践指南和政策第三版中，并确定了57项政策，其中包含与儿科实践广泛相关的健康建议指令。我们将个别建议文本提取到一个数据库中，并对其发布日期、主题进行编码，以及是否(1)在另一项政策中重复，(2)需要筛选问题以确定建议的目标人群，(3)政策本身引用了提供建议的讲义或其他辅助工具，或(4)声明文本引用了办公室提供建议的有效性的证据。结果。发现这57项政策包含192项独立的保健建议指令，儿科医生应向患者/监护人提供这些指令。这些指令中有7个（4%）是在1993年之前制定的，185个（96%）是在1993年至2002年间制定的。在删除30个（16%）重复项后，安全建议占67%，媒体使用占12%，药物滥用占5%，环境健康危害占4%，发育/情感健康占4%，性和怀孕占3%，营养占2%，杂项占3%。在41%的指示中，需要一个筛选问题来确定建议的目标人群。20%的政策提到了提供建议的辅助工具。在任何政策声明中，文本都没有提及办公室咨询是实现预期健康或行为结果的有效方法的证据。我们检查了美国儿科学会的政策声明，发现了162种不同的口头健康建议指令，儿科医生应该在整个儿童时期向父母和患者提供建议。期望能够实现所有这些建议的交付是不现实的。此外，经审查的陈述均未发现对建议意见的有效性进行循证讨论。鉴于这些发现，我们建议委员会在制定未来的政策声明时应考虑办公室健康咨询的可行性和有效性证据。
OBJECTIVE. The proliferation of policy statements from the American Academy of Pediatrics presents pediatricians with an increasing amount of health advice to deliver, yet no quantitative estimates of pediatric health advice expectations exist in the literature. The objective of this study was to quantify and characterize verbal health advice that pediatricians are expected to deliver to patients/guardians.METHODS. The authors read and coded the 344 American Academy of Pediatrics policy statements that are contained in the American Academy of Pediatrics' Pediatric Clinical Practice Guidelines and Policies, Third Edition, and identified 57 policies that contained health advice directives that are broadly relevant to pediatric practice. We extracted the individual advice text to a database in which we also coded its date of issue, its theme, and whether (1) it was duplicated in another policy, (2) a screening question was required to identify a target population for the advice, (3) handouts or other aids to delivering the advice were referenced in the policy itself, or (4) the text of the statement referred to evidence of the effectiveness of office-based delivery of the advice.RESULTS. These 57 policies were found to contain 192 discrete health advice directives that pediatricians are expected to deliver to patients/guardians. Seven (4%) of these directives originated before 1993, and 185 (96%) were created from 1993 to 2002. After removal of the 30 (16%) duplicates, safety advice composed 67%, media use composed 12%, substance abuse composed 5%, environmental health hazards composed 4%, development/emotional health composed 4%, sexuality and pregnancy composed 3%, nutrition composed 2%, and miscellaneous composed 3%. In 41% of the directives, a screening question was required to identify the target population for the advice. Aids to delivering advice were referenced in 20% of the policies. In no policy statements did the text refer to evidence that office-based counseling was an effective method to achieve the desired health or behavioral outcome.CONCLUSIONS. We examined the American Academy of Pediatrics policy statements and found 162 different verbal health advice directives on which pediatricians should counsel parents and patients throughout childhood. The expectation that delivery of all of this advice can be achieved is unrealistic. Moreover, none of the reviewed statements were found to include an evidence-based discussion of the efficacy of the suggested advice. In light of these findings, we suggest that committees should consider both the feasibility and the evidence of efficacy of office-based health advice when generating future policy statements.