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What medical professional is the most adequate to provide health care to children in primary care in developed countries? Systematic review

Authors:

Buñuel Álvarez JCa, García Vera Cb, González Rodríguez Pc, Aparicio Rodrigo Md, Barroso Espadero De, Cortés Marina RBf, Cuervo Valdés JJg, Esparza Olcina MJh, Juanes de Toledo Bi, Martín Muñoz Pj, Montón Álvarez JLk, Perdikidis Oliveri Ll, Ruiz-Canela Cáceres Jm

aPediatra. Área Básica de Salud Gerona-4. Instituto Catalán de la Salud. Gerona. España.
bPediatra. CS José Ramon Muñoz Fernández. Zaragoza, España.
cPediatra. CS Algete. Algete, Madrid. España.
dPediatra. CS Entrevías. Facultad de Medicina. Universidad Complutense de Madrid. Madrid. España.
ePediatra. CS Cáceres-Mejostilla. Área Sanitaria de Cáceres. Cáceres. España.
fPediatra. ABS Girona-3. Girona. España.
gPediatra. CS Ciudad Jardín. Badajoz. España.
hPediatra. Madrid. España.
iPediatra. CS Collado Villalba. Madrid. España.
jPediatra. Unidad de Gestión Clínica La Plata / Palmete. Sevilla. España.
kPediatra. Madrid. España.
lPediatra. CS. Juncal. Torrejón de Ardoz. Torrejón de Ardoz, Madrid. España.
mPediatra. Sevilla. España.

Correspondence: JC Buñuel. Email: jcbunuel@gmail.com

Reference of this article.:

Buñuel Álvarez JC, García Vera C, González Rodríguez P, Aparicio Rodrigo M, Barroso Espadero D, Cortés Marina RB y cols. ¿Qué profesional médico es el más adecuado para impartir cuidados en salud a niños en Atención Primaria en países desarrollados? Revisión sistemática. Rev Pediatr Aten Primaria. 2010;12:s9-s72.

Published in Internet: 31/03/2010

Abstract:

Introduction: There is controversy about which health professional is the most adequate -pediatricians (PED) or family practitioners/general physicians (FP/GP)- to provide health care services to children and adolescents in Primary Care (PC). There are not previous systematic reviews approaching this subject in the previously published literature. The objective of this study is to compare health care provided between PED and FP/GP in the following aspects of the clinical practice: antibiotic (ATB) prescription; diagnostic test indication; management of acute otitis media (AOM), asthma, febrile syndrome, and several psychopathological conditions, and preventive measures accomplishment.

Material and methods: Study design: Systematic review. Data sources: MEDLINE and CENTRAL databases, TRIP Database and Google Scholar, were searched until December 2008 to retrieve original papers and systematic reviews comparing the clinical practice of both kinds of health professionals. No language restriction was made. Study selection: studies of any kind of design were included (cross-sectional, cohort, case-control and experimental) comparing the clinical practice of PED and FP/GP. The references without original research were excluded (letters to the editor, editorials). The methodological quality of each study was assessed with the tool “OSTEBA; Critical Appraisal Cards”. Two reviewers assessed the quality of the studies independently, achieving consensus in case of discrepancy. Seven pairs of reviewers made the data extraction independently. Discrepancies were achieved by consensus.

Results: On average, FP/GP prescribed more ATB than PED in upper respiratory tract infections of probable viral etiology –odds ratio (OR): 1.4; 95% confidence interval (95% CI): 1.1-1.8–; PED were more likely to adhere to clinical guidelines recommendations on febrile syndrome management (OR: 9; 95% CI: 3-25) and on attention deficit disorder with/without hyperactivity (OR: 5; 95% CI: 3-11), and showed more resolution capacity on other highly prevalent conditions in children and adolescents (such as asthma and AOM). PED showed higher vaccination coverage than FP/GP in all the studies assessing this result.

Conclusion: Based on the presented results, it seems reasonable to recommend maintaining the PED figure in PC health centers and reinforcing its specific role as the first point of contact of the child with the health care system.

Keywords: Primary health care. Family practice. Physicians family. Paediatrics.

Conflict of Interest:

 All the authors of this revision are members of the Grupo de Trabajo de Pediatría Basada en la Evidencia (Evindece-based Pediatrics Work Group) that belongs to the Asociación Española de Pediatría de Atención Primaria (AEPap / Primary Care Pediatrics Spanish Association) and to the Asociación Española de Pediatría (AEP / Spanish Association of Pediatrics).

Funding: financial resources provided by the “Pediatría y Salud” Foundation (Madrid / Spain).

Note:

Translated by: Domingo Barroso Espadero, Paz González Rodríguez, Ana Benito Herreros, Pilar Aizpurua Galdeano, M.ª Jesús Esparza Olcina, Álvaro Gimeno Díaz de Atauri y Leo Perdikidis Oliveri (members of the Grupo de Trabajo de Pediatría Basada en la Evidencia (Evindece-based Pediatrics Work Group) that belongs to the Asociación Española de Pediatría de Atención Primaria (AEPap/Primary Care Pediatrics Spanish Association) and to the Asociación Española de Pediatría (AEP/Spanish Association of Pediatrics).

CS: Centro de Salud (Public Health Center of Primary Care). ABS: Áreas Básicas de Salud (Basic administrative areas of the Public Health Administration in certain places in Spain). Addresses for correspondence about this article: JC Buñuel, jcbunuel@gmail.com

This text is the English translation of Supplement No. 18, ¿Qué profesional médico es el más adecuado para impartir cuidados en salud a niños en Atención Primaria en países desarrollados? Revisión sistématica.

 

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