There has long been a great topic of debate and controversy: who is the most appropriate health professional to care for the pediatric population in primary care teams? This topic has been addressed over the years by numerous studies from different points of view (1).
Some authors have provided arguments in favor of the pediatrician and the pediatric nurse being in charge of the care of children in primary care, but there are also others who argue in favor of this care being carried out by doctors. . of family. It is paradoxical how, depending on one’s a priori vision and position on the subject, the same articles are cited by different authors to reaffirm opposing positions. We understand that this reflects the fact that either it is not possible to clearly identify differences, or the published articles have a low level of evidence.
A relevant issue in this debate is the difficulty of currently having the number of pediatricians to cover all primary care pediatric positions. However, studies on professional needs indicate that pediatrics and its specific areas are one of the specialties that will be in balance and without a high risk of meeting needs in the medium term (2).
The problems of filling places in primary care have been related to the care model and the little interest that primary care places have for young pediatricians who preferentially choose hospitals.
Faced with this situation, other professionals, mostly family doctors, have covered the needs of the national health system (SNS) for these vacant positions, while different strategies have been developed to try to cover all of them. the child population with a smaller number of pediatricians. Among these strategies is the creation of the figure of the area pediatrician in primary care or the models of integrated areas. In both cases, job insecurity and the decline in quality of care are elements that appear in the discourse.
The Spanish Association of Primary Care Pediatrics (AEPap) has published several studies on the situation of primary care pediatrics in different Autonomous Communities (CC.AA.), to subsequently publish on several occasions recommendations or organizational proposals to try to improve this situation (3, 4).
The reality is that a change is being introduced in the care model of pediatrics in primary care that is being implemented without a comprehensive analysis of the situation, without a reflection on the possible alternatives and without an evaluation of the impact on health that these may have. . organizational decisions.
It seems logical to begin a process of strategic reflection in the face of this situation, which should conclude in the development of a Strategic Plan for Pediatric Care that analyzes the reality we have in the SNS, that assesses future projections, that gives a voice to all the agents involved. . and that allows for consensus on the greatest number of initiatives to configure the pediatric care model for the coming years.
In this sense, there are proposals on the table to consider, such as reducing the number of reviews of the healthy child program, concentrating pediatric care in health centers that provide coverage to several basic health areas or the presence of pediatricians in primary care. . with a role as consultants, who would focus their work on chronicity care and community pediatrics, leaving ordinary consultation in the hands of family doctors.
At this point, it does not seem that it will be easy to answer the question we asked at the beginning: who is the most appropriate health professional to care for the pediatric population in primary care teams? Many more or less documented opinions, many editorials, many news items have been published, but few works that measure effectiveness, efficiency, health results, safety, adequacy or benefit with high levels of evidence.
We must also add the disparity in organizational models of care for the child population and the heterogeneity of the analyses, both in Spain and in Europe, which make comparisons methodologically difficult.
In addition, there are studies that have explored the preferences expressed by users/parents, in which it is worth highlighting that having pediatricians in primary care has been identified as a social achievement of well-being, and that parents prefer that pediatricians be the ones who care for their children. children. Although important aspects are also identified in this type of analysis.
From the review we have carried out, we believe that there are currently more arguments in favor of maintaining a care model with paediatricians and pediatric nurse specialists in primary care than there are arguments against abandoning this model. To these arguments we could add the forecasts of needs for family doctors in the coming years that identify a significant deficit of these professionals to cover the care needs of the adult population in the community setting.
In any case, faced with the possibility of a change in model, we think it would be desirable to promote observational studies in our environment that can evaluate the efficiency of pediatricians or family doctors caring for the child population; measure the impact that one or another child care service delivery system can have with appropriate indicators; or use real-life big data models as an approach to studies similar to clinical trials.
This should allow us to promote an informed debate about the care model that we want to have to better serve the child population. In addition, there are other needs that have been identified through strategic health planning and that must be addressed.
In the case of hospital care, it is necessary to advance in the recognition of the different areas of specialty-specific training (neonatology, pediatric gastroenterology, pediatric endocrinology, etc.). In addition, it is necessary to find solutions to the problems of on-call coverage in certain small regional hospitals to ensure offering 24x7x365 coverage. The organization and access to certain complex services with a high impact on health must also be addressed, such as extracorporeal membrane oxygenation (ECMO), pediatric CSUR, early care, or the organization of pediatric transport (especially in CC.AA ). .with great population dispersion or with insularity). Furthermore, each autonomous community must take into account its special characteristics and local problems when designing its model of care for children and adolescents.
Finally, adolescent care should be highlighted as a necessary field of development to train paediatricians, nurses and family doctors so that they can respond to the demands of these patients and their families or caregivers.
In this context, the question arises as to whether we need a Strategic Pediatric Care Plan in the SNS. It is not the first time that this question has been asked and there have been some Autonomous Communities that in recent years have carried out work in this sense although, for various reasons, they have not managed to publish said plans (5).
Different elements can be considered when justifying the development of said Plan. On the one hand, health systems need to adapt to demographic and social changes and have to offer responses to the needs of our population. The answers must be supported by updated scientific evidence, innovation, safety, good practices and quality of care. Properly prepared, they are a tool that really manages to improve the functioning of health services so that they are capable of reducing the impact of social determinants on the health results of the population to which they are directed.
In short, with this Plan the new social and economic challenges that we face from the public health system should be faced with efficiency, sustainability and solvency, without ceasing to consider that the opportunity costs of implementing some actions condition those other actions that they cannot be implemented.
The fundamental objective of the Plan would be to benefit, first of all, the children, their families and their caregivers. This objective will not be achieved without the necessary benefit that the professionals who care for these children will also obtain. And all this should improve the health not only of children but also of future generations of our population.
To achieve this objective, the Plan would have to establish lines of action that allow us to develop pediatric health care in an effective and efficient manner, that ensure equity of access to health resources and that, ultimately, contribute to optimizing the quality of care. assistance to the pediatric population taking into account available resources.
References:
(1) Buñuel Álvarez JC. et al. Which medical professional is best suited to provide health care to children in Primary Care in developed countries? Systematic review. Rev Pediatr Aten Primary. 2010;12:(Supplement 18): s9-s72
(2) Barber Pérez P., González López-Valcárcel B. Supply-Need Report for Medical Specialists 2021-2035. University of Las Palmas de Gran Canaria. January 2022. https://www.sanidad.gob.es/areas/profesionesSanitarias/profesiones/necesidadEspecialistas/docs/2022Estudio_Oferta_Necesidad_Especialistas_Medicos_2021_2035V3.pdf
(3) Decalogue of proposals to improve Primary Care Pediatrics. In; AEPap (online) (accessed 10/14/2022) Available in https://www.aepap.org/actualidad/noticias-aepap/decalogo-de-propuestas-de-mejora-de-la-pediatria-de-atencion-primaria
(4) Sánchez Pina C, Cantarero Vallejo MD, Gorrotxategi Gorrotxategi PJ, Villaizán Pérez C, Suárez Vicent E, Mambié Menéndez M, et al. 21 proposals for improvement for Primary Care Pediatrics in 2021. Rev Pediatr Aten Primaria. 2021;23:433-8
(5) Castaño Riera EJ, Martín Sánchez MJ, Bosch Fitzner A, Muñoz Alonso Y. SWOT analysis of Primary Care Pediatrics within the framework of a strategic plan. Poster presented at the 64th Congress of the Spanish Association of Pediatrics (AEP). Valencia, 2016
Not a: The opinions expressed in this work are the exclusive responsibility of the authors and do not represent the formal thoughts or opinions of the institution for which they work.
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