A controlled trial of parent initiated and conventional preschool health surveillance using personal child health records.
OBJECTIVES: A comparison of parent initiated preschool surveillance, using personal child health records, with the then current system of child health surveillance using child health records. DESIGN: Prospective, controlled trial with randomisation of five general practices into two groups. SETTING: Five general practices, a well baby clinic, and an orthoptic clinic at Yeovil District Hospital. SUBJECTS: 538 babies born between 1 April 1992 and 1 November 1994, from within the five general practices. MAIN OUTCOME MEASURES: The number of screenable abnormalities in the two groups that were missed in the first 3 years of a baby's life. RESULTS: 163 babies from the parent initiated preschool surveillance group and 107 from the conventional group completed the study. Although all the mothers from the parent initiated preschool surveillance group understood the concept of parent initiated surveillance, 117 stated their health visitor had made their appointments. Only 45 mothers made their own appointments. The abnormality rates were: 12 of 163 and eight of 107 at 1 year and nine of 163 and six of 107 at 3 years. No medically important conditions were missed. Most mothers did not want to make their own appointments because it was inconvenient. The system was unpopular with health visitors. CONCLUSION: Parent initiated preschool surveillance is as safe as the current system. Implementing the idea involved a small change in work practice and a large change conceptually for some of the primary health care team. It was not adopted in east Somerset.