ecpcp, prague 2015 primary care paediatrics (pcp) in europe* demography of care and forecast for the...
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ECPCP, Prague 2015
Primary Care Paediatrics (PCP) in Primary Care Paediatrics (PCP) in Europe*Europe*
Demography of Care and Forecast for the Demography of Care and Forecast for the ProfessionProfession
Manuel Katz MD, MPH President Israel Ambulatory Paediatric Society, Fmer President Israel Pediatric Society
Ben Gurion University , Israel and Maimonides University , Argentina
Fmer EPA Secretary General, EPCPC Tertiary care group representative to EAP
ISSOP board\council member, President , Global Initiative for Consensus in Pediatrics, CIP
WHO technical advisor
ECPCP, Prague 2015
ObjectivesObjectives
• To describe the organisation of the Paediatric Care at the Community and Primary Care level in the European countries
• To identify different types of Paediatricians working in the community.
• To understand variations of care for children between and within countries.
• To determine type of training offered to doctors who look after children at the Primary Care level.
• *Katz M et al . Pediatrics Vol 109 No 5, May 2002
ECPCP, Prague 2015
DefinitionsDefinitions• Paediatrician - A physician who finished his/her formal
training for paediatrics approved by the local health authorities or academic bodies in the country (either after under/post-graduate training).
• Primary Care Paediatrician - Paediatrician who offers curative and preventive services for acute and chronic problems in out-patient/ambulatory settings (primary care level).
• Community Paediatrician - Paediatrician who devotes to the comprehensive recognition and understanding, prevention and treatment of community related health problems (secondary/tertiary care level).
ECPCP, Prague 2015
PRIMARY CARE PEDIATRICIAN
Offers curative (general practice ) and health promotion (immunizations, school-care, etc.) for acute and chronic illnesses in out-patient or ambulatory settings like dispensaries, primary care clinics, health community centers or in private practice
Katz - 2001
ECPCP, Prague 2015
COMMUNITY PEDIATRICIAN
Devoted to the comprehensive recognition, prevention and treatment of community related health problems such as child protection, children in need, behavior problems, learning disorders, growth, developmental pediatrics, school medicine, etc.
Katz - 2001
ECPCP, Prague 2015
DefinitionsDefinitions
Primary Care Systems for children - defined according to the proportion of the country’s children aged < 15 years seen at the Primary Care level by either Paediatricians or General Practitioners/Family Doctors.
– More than 75% of children seen in the Paediatric System.
– 50% ± 25% children seen by both paediatricians and GPs offering primary care - Combined System.
– More than 75% of children seen by General Practitioner/Family Doctor - GP System.
ECPCP, Prague 2015
Differences in between and within countries
• Demography
• Socio-economic characteristics
• Background and culture
• Pathology
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ResultsResults
Demographic Data Mean (min-max; std-dev)
No of Children < 15 years inmillions
4.2 (0.1 - 34.1; 6.7)
% of population that are < 15years
22.7 (15.4 – 35.5; 5.7)
Infant mortality rate per 1000 11.4 (4.1 – 35.8; 8.2)
Income per capita ($) 11,427 (960 – 27,400)
ECPCP, Prague 2015
ResultsResultsProfessional Data Mean (min-max; std-dev)
Total no. of Paediatricians 4,924 (49 – 66,926; 11,756)
% of Paediatricians inPrimary Care
50 (0 – 92; 25)
% of Paediatricians inCommunity
11 (1 – 41; 12)
Total no of GPs 17,601 (12 – 158,670; 35,334)
Ratio of GPs to Total Paeds. 7 (0.02 – 38; 8)
No. of children per Paeds. 2,094 (400 – 15,600; 3,250)
In Israel: 20132180 Board certified Paediatricians1000~ Non certified Paediatricians
1658 General- Family Doctors
1 to 800 children up to 18
ECPCP, Prague 2015
ECPCP, Prague 2015
Patterns for Paediatric Care (Europe 2002, Katz and 2008, VanEsso)
mapa pediátrico
Medicina familiar
combinado
Falta de datos
ECPCP, Prague 2015
Training Received in Primary Care (PCP) and Training Received in Primary Care (PCP) and Community Paediatrics (CP)Community Paediatrics (CP)
51.2 48.839
61
0
10
20
30
40
50
60
70
80
90
PCP - Peads CP - Paeds
YesNo
41.5
58.5
14.6
85.4
0
10
20
30
40
50
60
70
80
90
PCP - GPs CP - GPs
Level of PC/Community paediatric training
(32 countries)
22 / 69%
5 / 16%
2 / 6%
3 / 9%
training in both pc
no community trainin
no primary care trai
no PC/comm training
ECPCP, Prague 2015
Hospital-based classic residency
16%
3%
3%
78%
Special track community-based paeds
9%
3%
9%
78%
PC/community paed training optional
3%
6%
91%
PC/community in paed CME programs
44%
16%
41%
Both PC& Community
Community
Primary care
Neither PC nor Community
Type of training (32 countries)
ECPCP, Prague 2015
ECPCP, Prague 2015
WHO IS CARING FOR CHILDREN IN THE COMMUNITY?
• Board certified family physicians• General practitioners• Board certified pediatricians• Pediatricians with special training in primary care• General practitioners with special training in
pediatric primary care• Nurse practioner
ECPCP, Prague 2015
CONCERNS ABOUT THE PROFESSIONAL FUTURE OF
PEDIATRICS
• Few pediatric hospital positions available
• Growing tendency to reduce the number of hospital pediatric wards
• Growing tendency to shift positions from the hospital to the community
ECPCP, Prague 2015
CONCERNS ABOUT THE PROFESSIONAL FUTURE OF
PEDIATRICS
• Health policy decisions regarding who should provide pediatric care at the primary care level:
• Who care for “new morbility”• Family physicians/general practitioners; Pediatricians
as consultants only; • Limiting the age of care by pediatricians (up to 2-to8-
to12-to18-to21?)
ECPCP, Prague 2015
FORECAST FOR THE PROFESSION
• Less candidates for residency in pediatrics
• Lack of academic positions at the community level
• Community positions filled by family physicians and by general practitioners with special training
• Non “profitable”profession• Non attractive profession• Gender related profession?
ECPCP, Prague 2015
FORECAST FOR THE PROFESSION
• Lack of planning for career development in community pediatrics
• Pediatrics to become a high technology, intensive care profession, forgetting its role in health promotion and health maintenance
ECPCP, Prague 2015
HOSPITAL, COMMUNITY AND UNIVERSITY COMMITMENT IS
ESSENTIAL
ECPCP, Prague 2015
TO PROMOTE CAREERS IN COMMUNITY PEDIATRICS:
• Create an early community experience for medical students
• Promote mentoring and learning activities for pediatric residents
• Ensure presence of academic primary and community pediatrics
• Focus support on pediatricians working in the community
ECPCP, Prague 2015
THANK YOU FOR YOUR ATTENTION
For comments and ideas:
Manuel Katz MD, MPH
Katzmanuel gmail.com
Phone + 972 50 6243342
Katz - 2005