Unaccompanied visits to the doctor in community pediatric clinics

Objective. Unaccompanied visits to the doctor by minors are a growing trend at community-based clinics in many areas of the world. The study describes which families utilize the practice and examines their motives in order to help formulate policy guidelines to ensure patient safety. Settings and sample. All visits by minors, age 4-18 years, during a 5-month period were recorded at one large clinic in a lower-income neighbourhood in the Tel Aviv area of Israel. Access to the clinic was unrestricted to members of the affiliated health maintenance organization. Methods. Data was based on a closed-ended questionnaire checklist, completed at the time of the visit by the secretary and corroborated by a parental telephone report. The visits were divided into three comparison groups: unaccompanied, accompanied by an older sibling, and accompanied by the parents themselves. Results. Data was submitted to multifactorial analysis. Unaccompanied visits were significantly correlated with a lower socio-economic status. There was a gradual loosening of the socio-economic status-association with increasing age. Large family size played a contributing role among the lower age group (p < 0.05). Distance from home to the clinic within the neighbourhood was not associated with this trend. Unescorted visits were significantly correlated (p < 0.01) with the degree of familiarity with the treating physician, as a function of the time the family as a whole had been in his/her care. The type of medical complaint also influenced the parents' decisions to send the child alone. Conclusions. Families seem to utilize a 'screening' mechanism in order to decide whether to send a child unescorted to the doctor. Large, overburdened, poorer families use the practice as a convenience in order to keep routine appointments, but only when they have known the staff for a long time and a trusting relationship exists. Implications for practice. In certain settings, treating unaccompanied minors might improve compliance with follow-up requirements of good medical treatment. Guidelines should be stipulated by local pediatric governing bodies in order to avoid mishap and abuse.