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• self selection and commitment are better indicators
  oscar,m jolobe
  Published on: 22 March 2016
• Nuances of category definitions
  Ingrid J Wolfe
  Published on: 22 March 2016

• Published on: 22 March 2016

  self selection and commitment are better indicators

  • oscar,m jolobe, retired geriatrician

  The statement that "countries with no or few paediatricians in primary care have satisfactory results in terms of conventional healthcare indicators such as neonatal and infant mortalities"(1) is,somehow, inconsistent with the complexity of the data required for calculation of most of the 38 healthcare indicators required to assess more precisely differences between various systems of delivery of paediatric primary care(...

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  The statement that "countries with no or few paediatricians in primary care have satisfactory results in terms of conventional healthcare indicators such as neonatal and infant mortalities"(1) is,somehow, inconsistent with the complexity of the data required for calculation of most of the 38 healthcare indicators required to assess more precisely differences between various systems of delivery of paediatric primary care(1). Even if it were true that different systems all produce the same evental mortality outcomes, outcomes such as neonatal and infant mortalities are very crude indicators of quality of paediatric primary care and patient satisfaction. In the absence of data which are truly sensitive to quality of care and patient satisfaction, a more pragmatic approach would be to assume that those doctors who elect to do a stint in paediatrics as a preparation for general parctice(as I myself did before entering general paractice in South Africa) are a self selcted group who are keenly aware of the vulnerability of children. By the same token specialist paediatricians who choose to work in the community are a self selected group who recognise that children are just as vulnerable in primary care as they are in secondary care. Accordingly, direct access to general practitioners who ahve a special interest in paediatrics, and also to primary care specialist paediatricians should be unhindered, and systems should be put in place to make it easier for parents to identify which general practitioners have a special interest in paediatrics and how they should obtain direct access either to those specially identified general practitioners or to specialist paediatricians based in primary care. These are the doctors who should be gatekeepers to secondary care, and they should be nurtured, and their job satisfaction and continuing professional development enhanced by ongoing dialogue with their collegues in secondary care through the medium of participation in post-take rounds, grand rounds, and teach-ins.

  References

  (1) van Esso D., del Torso S., Hadjipanayis A et al Paediatric primary care in Europe: variation between countries Arch Dis Child 2010;95:791-795

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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• Published on: 22 March 2016

  Nuances of category definitions

  • Ingrid J Wolfe, Child Public Health Research Fellow
  • Other Contributors:
    • Martin McKee, Staffan Janson

  Van Esso et al highlight interesting differences in primary care provision between European countries, pointing out a possible change in the relative balance between paediatric and general practitioner/family doctor systems since Katz's paper in 2002(1). Our findings, from an ongoing study for the European Observatory on Health Systems and Policies, suggest caution in the interpretation of GP/FD models in some countries....

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  Van Esso et al highlight interesting differences in primary care provision between European countries, pointing out a possible change in the relative balance between paediatric and general practitioner/family doctor systems since Katz's paper in 2002(1). Our findings, from an ongoing study for the European Observatory on Health Systems and Policies, suggest caution in the interpretation of GP/FD models in some countries. For example Swedish general practitioners and paediatricians work in teams with children's nurses in urban community-based children's centres. Rapid referrals and consultations are easy and commonplace, rendering the distinction between types of professionals less clear. Some children's centres are staffed by either a GP/FD or a primary care paediatrician, and in rural areas the GP/FD model predominates. In Sweden, planning children's health services for an area is the responsibility of a senior paediatrician and paediatric nurse. Similarly in The Netherlands, the transmural care model enables GPs and paediatricians to work more closely together than is the case in the UK by aligning financial and managerial incentives. Hence although defining these countries as having a GP/FD model for children's first-access is correct, it is an incomplete explanation as they have advanced further along the road to integrating primary and secondary care than the UK.

  1. Katz M RA, Collier J, Rosen J, Ehrich JHH. Demography of pediatric primary care training in Europe: delivery of care and training. Pediatrics. 2002;109:788-96.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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