Injury Prevention Counseling during Well-Child Visits to U.S. Physicians: 2005-2009

Background: Pediatric and adolescent injury prevention counseling (IPC) is recommended by professional medical academies. We examined rates and determinants of IPC during preventive care (“well-child”) visits in US ambulatory care settings.

Methods: Data were from the National Ambulatory Medical Care Survey, a probability sample survey conducted annually by the US National Center for Health Statistics and designed to represent all US office-based physician visits. Data from 2005 to 2009 were merged and then restricted to preventive care visits involving children less than 19 years of age. We conducted descriptive analyses on rates of IPC by patient and clinic characteristics and estimated the likelihood of IPC in reference to hypothesized determinants. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression.

Results: There were approximately 282.8 million (CI: 252.9-312.7) well-child visits in US office-based physician clinics from 2005 to 2009; 24% involved IPC. Patient gender was not associated with IPC, but age, race/ethnicity, payment type, and region were. Rates of IPC decreased from 27% in visits with children aged 0-2 to 16% in those aged 13-18 years. Compared to non-Hispanic Whites (26%), rates were lower for Black patients (19%; OR=0.7; CI=0.6-0.9). Visits in rural regions were less likely to involve IPC (16%; OR=0.6; CI=0.4-0.7) than visits in urban regions (25%).

Conclusion: IPC can reduce injury rates among pediatric patients. Public health efforts should focus on increasing overall rates of IPC. Emphasis on children who are older, minority, and seeking preventive care in rural regions may be needed.