PRIMARY HEALTH CARE FOR CHILDREN AMONG THE ECPCP

MEMBER COUNTRIES

ECPCP SESSON BALTIC PEDIATRIC CONGRESS

VILLNIUS, MAY 21, 2011 Yona Amitai

In behalf of the Scientific Working Group

ECPCP Scientific Working Group: GOALS

• Improve the professional level of Primary Care Paediatrics (PCP) at all levels of the medical education; Medical schools, the Paediatric Residency and post-graduate programs for Paediatricians in PCP.

• Such programs should be prepared in full accordance between the European Academy of Paediatrics (EAP) and the ECPCP to ensure the future of PCP as an essential health service for children throughout Europe, based on modern, updated academic and consensual medicine.

• This goal should be achieved by integrating PCP training as an essential component in the Curriculum of Medical schools and Paediatric Residency Programs, and developing Continuous Medical Training (CME) in PCP.

• Evaluate the training programs in PCP of the Member States of the ECPCP, with the long term goal to improve harmonization of such programs, and develop a unified Cor-Curriculum program in PCP in Europe.

• Encourage Junior Paediatricians practicing in PCP for orientation to research and teaching in PCP to ensure the development and the future of PCP as an academic high level and prestigious health profession.

• Advocating and lobbying for PCP issues to be discussed in all paediatric congresses in the EU.

THE SHARE OF PRIMARY CARE

1000 people

800 have symptoms

327 consider seeking

medical care

217 visit a physician’s office

113 visit primary care

physician’s office

65 visit CAM provider

21 visit a hospital OPD

14 receive home health

care

13 visit an emergency

department

8 in a hospital

<1 in an academic health

center

New Ecology of Medical Care - 2001

NEJM 2001, Green et al

Copyright ©2003 American Academy of Pediatrics

Dovey, S. et al. Pediatrics 2003

Fig 1. Participation in medical and dental care in a typical month for 1000 children and adolescents aged 0 to 17 years (A), and 1000 adults ≥ 18 years (B)

THE IMPORTANCE OF TRAINING: EXPLOSION OF KNOWLEDGE

The number of publications on:

Children, protocol, guidelines in PubMed / year

359

471 477

562 648

490

652

759 801

923

0

100

200

300

400

500

600

700

800

900

1000

5-10 years 3-5 years 2-3 years 1-2 years last year

protocols

guidelines

Raphael, National Gallery of Art, Washington, DC

Children are not little Adults Pediatricians are Not little internists

1ST STEP: MAPPING THE CURRENT STATE IN THE ECPCP MEMBER STATES

SURVEY OF THE (BASELINE) STATE

OF PCP MANPOWER, TRAINING

AND NATIONAL PROGRAMS

Objectives:

To improve the professional level of Primary Care Paediatrics (PCP):

An evaluation of the current state of the PCP service and

training programs in PCP at all levels of the medical education.

METHODS

• The state of PCP in 16 Member States of the ECPCP in 2011was reviewed for:

- training programs in PCP

- the availability of pediatricians

- the availability of primary care pediatricians

• Data were provided by the ECPCP delegates of each country.

• Additional demographic data were extracted from official WHO publications.

Country Faculty

Members at

Medical

Schools

Pediatric Residency Fellowship in

PCP

CME in PCP

Curriculum in

Paediatrics

Obligatory / Elective PCP

1 Austria yes + (EAP) elective no Obligatory no exams

2 Cyprus no no (starting) yes no

3 Czech yes Yes – in PCP Obligatory, 1 yr no yes

4 France no yes elective no obligatory no exams

5 Germany no Yes no no Yes, variable

6 Hungary no Yes Obligatory, 2 months no Obligatory no exams

7 Israel yes yes elective no Yes, variable

8 Italy no Yes, variable no no Yes, required

9 Latvia no residency

10 Lithuania yes Yes, variable obligatory yes not official

11 Luxembourg no No med. schools no no Not official

12 Portugal yes yes Obligatory, 6 months no No

13 Slovakia GP for children? Yes

14 Slovenia no yes Obligatory, 6 months no Yes

15 Spain (yes) yes Obligatory, 3 months no Yes, variable

16 Swiss no yes no no Obligatory-SSP

Country No live

birth per

year

(1,000)

UNICEF

2010

No < 15

years

(1,000)

Num

Pediatr

Child /

pediatr

Number

PCP No

child /

PCP

Upper

age for

children

treated

by

Paediat

Working

Force for

planning

pediat Manpower

% children

treated by

Paediatrician

Health

Indicators

1 Austria 76 1,140 500 2,280 18 yes ? yes

2 Cyprys 10 150 234 641 180 833

3 Czech 119 1,488 3,286 452 2,052 725 18 yes 100 <15

80 (15-19)

yes

4 France 752 11,280 6,000 1,880 2,550 4,424 18 (16) no 20 (vaccine)

5 Germany 666 11,000 11,973 835 5,634 1,950 18 91<6

65 (7-10)

34 (11-17)

No

(diversity)

6 Hungary 99 1,421 2,500 594 1,586 936 18+ starting 73

81 < 5

Yes

7 Israel 160 2,100 2,200 955 900 2,333 16 yes 60 Yes

8 Italy 546 8,190 14,000 585 7,000 1,170 14 No 44 (vaccine)

9 Latvia 23 345 876 394 18 no (vaccine)

10 Lithuania 32 499 1,194 472 464 1,075 18 62.5 (vaccine)

11 Luxembourg 5 75 65 18 No

12 Portugal 105 1,624 1,486 1,100 18 No ? Yes

13 Slovakia 55 825 2,500 330 1,023 806

14 Slovenia 22 310 481 644 279 1,111 19 Yes 80 (vaccine)

15 Spain 491 7,365 11,000 670 2,300 3,202 16-18 no 20-90 (vaccine)

16 Swiss 73 1,035 18 20-90 (vaccine)

RESULTS (1): Health services and availability of Pediatricians

• In most countries the upper limit of children served by pediatricians is 18 years.

• The % of children cared by pediatricians is variable (20-100%), in only 2 countries (Czech and Lithuania) 100% of children are cared by pediatricians.

• In 2 countries (Germany and Hungary) the % of children cared by pediatricians is higher for preschool children than for older children.

• The ratio between the numbers of children < 15 and the number of pediatricians in the country varies between 330 children per pediatrician in Slovakia to 1,880 children per pediatrician in France.

RESULTS (2) Training Programs

• A curriculum for pediatric residency exists in 11 countries

• An obligatory component of PCP, as a part of the residency exists in 5 countries, varying between 2-6 months in some counties to 2 years.

• Fellowship in PCP was reported only from Cyprus and Lithuania.

• Continues Medical Education (CME) in PCP existed in most countries, but is obligatory in only 4 countries, however no exams are required.

CONCLUSIONS • A large variability

• Different models

• Develop a uniform Curriculum

• Strengthen the PCP component in:

- medical students training

- pediatrics residency

- post-graduate CME

• Research on efficacy, proficiency and cost of health services to children

1st International Congress on Pediatric Primary Care, Tel Aviv 11-13 May, 2011

• Increasing recognition of the importance of Pediatric Primary Care, a strategic step for:

- Improving health care of children - Reduce the use of hospitals - Reducing health and social costs to the

society • Research and evaluation on PCP • Advocacy and change in Health Policy

Country Member (s)

1 Austria Wilhelm Sedlak

2 Cyprus Despina Economu

3 Czech Republic Natalia Szitanyi, Nadia Kocnarova, , Olga Roskotova

4 France Marie Josee Simon-Gherdi, Remi Gatard

5 Germany Ulrich Fegeler. Klaus Rodens

6 Hungary Gyori Jozsef

7 Israel Yona Amitai

8 Italy Laura Reali

9 Latvia Imants Lanka

10 Lithuania Arunas Valiulis, Janina Lajauskaite

11 Luxembourg Emile Tockert

12 Portugal Fatyma Pinto

13 Slovakia Patricia Goldenberg, Kvestoslava Prcuchova

14 Slovenia Margareta Seher-Zupancic, Ajda Cimperman

15 Spain Elena Cid Fernandez, Patricia Meseguer

16 Swiss Francoise Bovet-Boone

SCIENTIFIC GROUP MEMBERS

The needs of children should always be met.

While children are often the victims of fate, they should never be victims of neglect…

JF Kennedy