Ambulatory paediatrics

Management of problems related to the new morbidity by community-based paediatricians in Israel

OBJECTIVES

To assess community-based paediatricians' management of clinical situations, particularly those related to the new morbidity (NM), such as chronic disease, developmental, behavioural, and psychosocial problems, and to identify the main associated factors.

METHODS

The study population included all community-based paediatricians employed by Israel's two largest health maintenance organizations in the central and southern regions of the country (n= 574; 74% response rate). Using a self-administered questionnaire including 20 vignettes describing common clinical situations (14 related to NM; 6 related to classic paediatrics (CP)), physicians reported how they would manage each situation and how they perceived their role in managing such problems.

RESULTS

Paediatricians were less likely to take an active role in managing NM-related problems than CP-related problems (68.3% vs. 93.2%; P < 0.001). In most NM situations, when paediatricians regarded the problem as part of their role, they were more likely to either manage the problem by themselves or with the help of other professionals. A multivariable linear regression model, adjusting for demographic, practice and training characteristics indicated the following predictive factors for taking an active role in managing NM (P < 0.001): practicing in the periphery, consulting with non-medical community-based professionals and combining community and hospital practice.

CONCLUSIONS

To assure comprehensive paediatric care, simultaneous modification of paediatricians' residency training, practice environment and role perception are required.