Demography of pediatric primary care in Europe: Delivery of care and training
Demography of pediatric primary care in Europe: Delivery of care and training
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DOI：
10.1542/peds.109.5.788
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发表时间：
2002-05-01
期刊：
影响因子：
8
通讯作者：
Ehrich, JHH
中科院分区：
文献类型：
--
作者：
Katz, M;Rubino, A;Ehrich, JHH
Objective.欧洲国家儿科学会和协会联合会承认，缺乏关于提供护理的人口统计资料和对欧洲儿童护理医生的培训。因此，欧洲国家儿科学会和协会联盟研究了各国之间关于儿科初级保健（PPC）和社区儿科（CP）以及为那些在社区一级照顾儿童的人提供的正规培训程度的差异的因素和解释。向欧洲41个国家儿科学会的主席邮寄了一封解释信和一份调查问卷，其中有12个关于PPC和CP的交付和培训的问题。有关人口、国家收入和婴儿死亡率的统计数据也来自世界卫生组织的数据。采用多元和线性回归进行统计分析，以确定哪些变量与IMR相关。关于人口统计学和培训的描述性统计数据也进行了说明。1999年，共有167 444名儿科医生为生活在34个报告的欧洲国家的1.58亿15岁以下儿童提供服务。每名儿科医生的平均儿童人数为2094人，从401人到15150人不等。12个国家存在PPC的儿科系统; 6个国家有全科医生系统，16个国家报告了联合系统。在3个国家，儿科医生根本没有在初级保健一级工作。在34个国家中，有14个国家的儿科医生从事社区医学的各个方面，如发育儿科学、婴儿保健、学校医生等。人均收入较高的国家婴儿死亡率较低。此外，当将IMR视为结果时，儿科初级保健系统具有保护作用。在75%的国家中，报告了对儿科医生进行某种形式的儿科护理培训;全科医生的相应数据为60%。仅在少数国家向儿科医生和全科医生提供了以社区为基础的教学计划。在世纪末，欧洲在PPC的提供和对儿童护理医生的培训方面表现出相当大的差异。这项研究确定了PPC的3种不同的医疗保健提供系统，以及在社区环境中工作的2种儿科医生。儿科医生和全科医生的PPC或CP的正式培训从既定的课程到根本没有教学。经济和社会政治问题，专业力量，地理和历史因素可以解释欧洲国家之间儿科护理的差异。
Objective. The Union of National European Pediatric Societies and Associations recognized the lack of information regarding demography of delivery of care and training for the doctors who care for children in Europe. Therefore, the Union of National European Pediatric Societies and Associations studied factors and explanations for the variation between countries regarding pediatric primary care (PPC) and community pediatrics (CP) as well as the extent of formal training provided for those who take care of children at the community level.Methods. An explanatory letter and a questionnaire with 12 questions regarding delivery of PPC and CP and training was mailed to the president of each of 41 national pediatric societies in Europe. Statistical data about population, country's income, and infant mortality rate (IMR) were also obtained from World Health Organization data. Statistical analysis using multivariate and linear regression was conducted to ascertain which variables were associated with IMR. Descriptive statistics regarding demography and training are also reported.Results. In 1999, a total of 167 444 pediatricians served a population of 158 million children who were younger than 15 years and living in the 34 reporting European countries. The median number of children per pediatrician was 2094; this varied from 401 to 15 150. A pediatric system for PPC existed in 12 countries; 6 countries had a general practitioner system, and a combined system was reported from 16 countries. Pediatricians did not work at the primary care level at all in 3 countries. In 14 of 34 countries, pediatricians worked in various aspects of community medicine, such as developmental pediatrics, well-infant care, school physicians, and so forth. IMR was lower in countries with a higher income per capita. In addition, a pediatric system of primary care had a protective effect when looking at IMR as the outcome. In 75% of the countries, some form of training in pediatric care for pediatricians was reported; the corresponding data for general practitioners was 60%. Community-based teaching programs were offered to pediatricians and general practitioners in a minority of countries only.Conclusions. At the end of the century, Europe showed a considerable variation in both delivery of PPC and training for doctors who care for children. This study identified 3 different health care delivery systems for PPC, as well as 2 types of pediatricians who work in community-based settings. Formal training in PPC or CP for both pediatricians and general practitioners varied from established curricula to no teaching at all. Economic and sociopolitical issues, professional power, and geographical and historical factors may explain the differences in pediatric care among European countries.