Coverage of point-of-care testing still is inadequate, Dr. Simon said. “It’s a payer barrier to delivering care in a timely manner,” he said.
Another recommendation made in 2014 and reflected in the newly published schedule advises pediatricians to use the CRAFFT (Car, Relax, Forget, Friends, Trouble) screening questionnaire as a tool to screen adolescents for drug and alcohol use. Specific tools are not usually recommended, Dr. Hagan said, but the CRAFFT screen “is validated and has been sufficiently widely used that we recommend it.”
One challenge, Dr. Kinsella said, is allowing enough time for the teen patient to fill out two screens – CRAFFT and a depression screening tool. “Ideally,” she added, “patients could fill them out on an [EHR] patient portal,” with confidentiality ensured.
The upcoming revised edition of the Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents – expected in late spring or early summer of 2016 – will offer more guidance on previsit screening, which is valuable because “it moves some of this time away from the [limited] face-to-face time that you have, so you know where to focus your time in the visit,” said Dr. Hagan, coeditor of Bright Futures.
“We’re looking at making these visits efficient, efficacious, and most importantly, doable,” he emphasized.
The 4th edition of Bright Futures will include another freshly updated periodicity schedule that likely will include maternal depression screening and a recommendation for developmental screening at 4 years, as well as an expanded window for HIV testing from the current 16-18 years to 15-21 years, said Dr. Hagan, who previewed the new edition at the AAP annual meeting.
As Bright Futures and the Committee on Practice and Ambulatory Medicine deliberate these potential additions to the schedule, “we [will consider] how much these screening recommendations can impact and improve child health, and if a busy pediatrician can perform them in a time and cost-effective manner,” Dr. Simon said.
An up-to-date periodicity schedule can be accessed here.