Taylor and Kemper1 are to be congratulated for their interesting look at group well-child care (GWCC) in the June issue of the ARCHIVES. Given the challenges of providing comprehensive, effective well-child care to a high-risk population and the importance that we as clinicians and public policy shapers have placed on this care, it is absolutely essential that such research be carried out.
However, this study has serious limitations that may jeopardize the results. The first is the uneven distribution of important maternal characteristics between the intervention groups after the randomization process. The authors acknowledge in the "Results" section that the GWCC mothers were significantly more likely at study outset to be abusing alcohol or other drugs than the individual well-child care (IWCC) mothers. They fail to comment, however, on how this uneven distribution may have influenced the overall results. Indeed, given that the GWCC mothers were roughly 3 times as likely to test positive for alcohol abuse and more than twice as likely to test positive for other substance abuse as the IWCC mothers, it is remarkable that both groups had similar outcomes. Did the authors try to control for this potential bias?
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