Citation

Visscher SJA, van Stel HF. Child Abuse Negl. 2017; 70: 264-273.

Affiliation

Department of Healthcare Innovation and Evaluation, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands(1). Electronic address: h.vanstel@umcutrecht.nl.

Copyright

(Copyright © 2017, Elsevier Publishing)

DOI

10.1016/j.chiabu.2017.05.020

PMID

28641135

Abstract

Child maltreatment (CM) is a common condition with a large impact on the victim and society. In the Netherlands, the preventive child healthcare (CHC) aims to protect children against such threats. However, several studies indicate that the efficacy in this area may be suboptimal for many CHC professionals. Therefore, this study aims to map the practice variation in the primary and secondary prevention of CM, by CHC physicians and nurses. This mixed-methods study used interviews to identify relevant topics and develop an online questionnaire. All CHC organizations in the Netherlands (n=45) were asked to forward this questionnaire to their professionals. Practice variation was described with domain scores and item response distributions. Multi-level analysis was used to assess case mix-corrected variance between organizations. Interview participants (n=11) expected suboptimal care in 35 topics which they considered important for prevention of CM, resulting in a 15min questionnaire. Nearly two-thirds of the organizations (n=29) agreed to forward the questionnaire to their employees. The response rate was 42% (n=1104). Suboptimal care and practice variation was found in all domains (i.e. communication, medical expertise, collaboration, involvement in prevention of CM, and improvement opportunities), mostly caused by intra-organization variance. Significant inter-organization variance was found for collaboration (variance partition coefficient 6-7%) and involvement (2-3%). Furthermore, the majority of the respondents (96%) reported fear in acting upon suspicions of CM. Substantial suboptimal care and practice variation in prevention of CM warrant action from authorities, CHC training institutes, CHC organizations, and professionals.

Copyright © 2017 Elsevier Ltd. All rights reserved.

Language: en

Keywords

Child health care nurses; Child health care physicians; Child maltreatment; Practice variation; Prevention; Preventive child health care