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Primary care in pediatrics: the situation in Europe

Per richiamare l’attenzione sull’importanza delle cure primarie l’OMS ha di recente lanciato lo slogan Primary health care -Now more than ever (The world health report. WHO, 2008). Se da un lato sembra ovvio che la figura di riferimento delle cure primarie in età pediatrica debba essere il pediatra (Cheng TC. Pediatrics 2004;113:1802-9), risultati soddisfacenti in termine di indicatori di salute pediatrica sono stati ottenuti anche in alcuni Paesi che escludono il pediatra dalle cure primarie (Katz M, et al. Pediatrics 2002;1098:788-96). Laddove è il medico di famiglia a occuparsi in prima battuta del bambino il dibattito è aperto su quanta pediatria il medico sappia effettivamente, sulle sue capacità di selezionare correttamente i bambini da inviare in ospedale e sulla scarsa garanzia data da questo sistema in termini di azione preventiva. Nei Paesi in cui le cure primarie ai bambini sono erogate da specialisti pediatri si teme invece che l’accesso non selezionato e diretto allo specialista pediatra produca un eccesso di intervento non necessario (costoso e potenzialmente dannoso) e che in prospettiva il numero degli specialisti pediatri non sarà più sufficiente (Stephenson T, et al. Arch Dis Child 2010;95:767-8).

Uno studio sponsorizzato the European Academy of Paediatrics covering 29 countries and is the picture of the organization of pediatric primary care in Europe (Van It D, et al. Arch Dis Child 2010; 95:791-5, see also the Italian translation stated on M & B site ). Things vary considerably from country to country, from the fact that the same childhood is considered in a different way (0-14 half, 0-18 or 0-19 and the other half). The countries where pediatric primary care are handled in the first instance to the pediatrician are only 7 (Israel, Czech Republic, Slovakia, Greece, Cyprus, Spain, Slovenia) and are in sharp decline (from 35% to 23%) compared to a survey a decade ago (M. Katz Pediatrics 2002; 109:788 - 96). Cala and the proportion of countries (from 47% to 35%) who have a mixed system (among them is put Italy) in which the pediatric primary care are performed by the pediatrician but also where you can choose from different individual family or is there a different approach because of the type of intervention (preventive or clinical care). They go hand
countries where primary care pediatric pass through the filter of the general practitioner / family doctor (18% to 41%). In these countries the training of pediatric general practitioner / family doctor only lasts an average of four months. It is perhaps

a work of little use to draw conclusions: it has the objective limit of not offering any evidence to evaluate the performance of the models adopted in different countries in terms of concrete health of children. But seem to work to read, a starting point to reflect in a moment of great uncertainty and identity crisis of Pediatrics.

From Yellow Pages of Medical and Child , October 2010