re: Ontario's new enhanced 18-month well-baby visit

ijohnston — Thu, 01 Jul 2010 18:17:26 GMT

Few paediatricians would argue with the advantages of proactively identifying children early on who show signs of developmental concerns. The enhanced 18 month screen seems like a reasonable intervention. Unfortunately, in medicine things that seem to be intuitively reasonable do not always yield the anticipated results when the evidence is actually examined. There is abundant evidence that early interventions positively impacts on long term outcomes. What evidence do we have that early screening has a positive impact. Obviously, the assumption is that early screening will lead to early interventions. Do we know that this is the case? Do we have the resources to supply early interventions to large numbers of children who are identified? The data presented suggest that 25% of children will be tagged during the 18 month screen. Is there a strategy to deal with these massive numbers? Once these large numbers are infused into an already strained system, are we sure that we will reap the benefits that might be anticipated if these children received "gold standard" intervention as is often the case in clinical trials? Do we have any pilot studies showing that early screening (not early intervention) improves long term outcomes?

McMaster has a well deserved reputation for evidenced-based medicine. The evidence pertaining to this initiative that I am aware of is indirect at best (yes, early intervention is helpful, but intervention is downstream of this initiative). Before embarking on an extremely labour intensive and expensive program such as this, I would like to see more direct evidence that the plan workable and will yield the desired results.

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re: Ontario's new enhanced 18-month well-baby visit