Effective Patient Care in the Pediatric Ambulatory Setting: A Study of the Acute Care Clinic

Our study used family compliance and understanding as indices of effectiveness. In a control population of 142 cases, effectiveness averaged 52% of the desired level but only 8% achieved desired levels of effectiveness in all measured categories. Scores were highest in appointment keeping, lowest in understanding of the child's condition, and intermediate for medication taking and procedure performance. The services of family health management specialists were added to the regular clinic services and resulted in significant improvement in all measured categories. These specialists were trained public health nurses and directed their efforts to an understanding of total family health situation and the capacity and resources of the family for completing recommended care. They undertook full responsibility for medical follow-up in a significant number of cases. Through them the average percentage of effectiveness was raised to an average of 82% of the desired level, although only 31% of the cases were judged to be at an adequate level in all of the categories. Questions still unanswered are which aspects of the services of the family health mnanagemcnt specialist were responsible for the improvement in effectiveness, whether non-professionals can achieve the same improvements, and whether such services can he applied to other clinic and private practice settings.