Pediatricians' Roles in the Provision of Developmental Services: An International Study

Synopsis

A 10-nation study examines how the provision of pediatric developmental services is apportioned among different types of health care providers— pediatricians, general practice physicians, and nurses. In doing so, the researchers shed light on the uniquely broad role that U.S. pediatricians play in delivering child health care.

The Issue

In recent years, U.S. pediatricians have seen their role expanded to include primary care prevention and health promotion, with an expectation that they will cover an ever-widening array of topics during office visits. Recommendations from the American Academy of Pediatrics exceed what pediatricians can realistically provide within standard visits. Given the tension between expectations and current practice, the researchers set out to explore how child health services are delivered in other industrialized countries, and to glean lessons that might help U.S. pediatric practices fulfill the increasingly complex roles demanded of them.

Key Findings

Of the 10 countries studied—Australia, Canada, Denmark, England, France, Germany, Japan, the Netherlands, Spain, and Sweden—most divide responsibility for primary care developmental services among more than one type of health professional (e.g., pediatrician, general practice physician, nurse) and setting (e.g., medical group practice, multidisciplinary community center).
In six of the 10 countries, the monitoring of young children’s development is primarily the responsibility of nurses working in geographically based community centers.
In most of the countries, nurses are responsible for anticipatory guidance and parent education, as well as for developmental counseling for particular problems, such as tantrums.
Care coordination and referral can be the responsibility of different health care providers in the various countries, but follow-up and care coordination for more specialized developmental services, such as early intervention, are usually the responsibility of a general practice physician or pediatrician.

Addressing the Problem

In the United States, pediatricians are primarily responsible for all child health services—acute care, developmental monitoring, health supervision, referral, and care coordination. But many other industrialized nations divide responsibility among health care professionals, with pediatricians focusing on providing specialized developmental care for children with identified problems, as well as managing chronic conditions. In some cases, a national maternal and child health care infrastructure also carries some of the burden. To improve outcomes in the U.S., we face a choice between building more support around the pediatrician-focused medical home model and dividing responsibility for services among providers, say the authors.

About the Study

The study team performed structured interviews with 20 child health care experts in 10 countries: Australia, Canada, Denmark, England, France, Germany, Japan, the Netherlands, Spain, and Sweden. Participants were asked to respond to four scenarios representing common diagnostic and treatment issues in pediatric developmental health.

The Bottom Line

Involving nurses, general practitioners, and other clinicians in the delivery of developmental services might enable children in the United States to receive more thorough and effective care.

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