title: Unanswered questions prompted during pediatric primary care visits.
abstract: OBJECTIVE
  To identify the frequency, types, and perceived importance of questions prompted during primary care visits for which pediatricians have no ready answer; to characterize pediatricians' responses to them; and to determine how questions prompted while caring for children with special health care needs (CSHCN) and children without special needs (Cw/oSN) differ.
  
  
  METHODS
  Patient visits with 35 general pediatricians were observed. Parents completed a CSHCN screener. Physicians provided details about their unanswered questions and their pursuit of answers.
  
  
  RESULTS
  Of 890 observed visits, 170 (19.1%) prompted unanswered questions, of which 60.1% were deemed important or very important. Physicians intended to pursue answers to 49.7% of the questions but actually pursued answers for only 27.5%, citing lack of time and inadequate information resources as barriers. One hundred sixty-seven (18.8%) visits were with CSHCN. Unanswered questions arose more often with CSHCN than with Cw/oSN (28.7% vs 16.9%; odds ratio 1.98; 95% confidence interval, 1.32-2.97), particularly during well visits (34.6% vs 14.9%; odds ratio 3.24; 95% confidence interval, 1.59-6.39). CSHCN prompted more diagnosis and treatment questions than Cw/oSN. Questions prompted by CSHCN were ranked as more important but were no more likely to be pursued than those prompted by Cw/oSN.
  
  
  CONCLUSIONS
  Unanswered questions arise during nearly 20% of pediatric primary care visits. Visits with CSHCN, particularly well visits, generate more questions than those with Cw/oSN. Answers are pursued for few unanswered questions, both overall and for CSHCN. Potential strategies to overcome barriers to answering questions include scheduling more time or more visits for CSHCN.
authors.affiliation: Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA. chuck.norlin@hsc.utah.edu
authors.forename: Chuck
authors.initials: C
authors.lastname: Norlin
authors.forename: Adam L
authors.initials: AL
authors.lastname: Sharp
authors.forename: Sean D
authors.initials: SD
authors.lastname: Firth
mesh_terms: D000328:Adult; D002648:Child; D002983:Clinical Competence; D006801:Humans; D009819:Office Visits; D010353:Patient Education as Topic; D010372:Pediatrics; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011368:Professional-Family Relations