Symposium on the practice and
the evidence of prevention in
pediatric primary care
ECPCP meeting Prague
nov. 2015
WELL-CHILD CARE VISITS
Prenatal
and
Well child
care
Well
child
care
Prenatal
phase
Infancy
first 11 m
1-4
years
5-10
years
11-18
years
Total
Visit
4-8
5-6
3
2
3
17-22
Visits
5-6
3
2
3
13-14
Visits
Age dependent coverage, results,
cost- efficiency, evidence?
Our association has a national work group called
Previnfad that investigates and publishes about costefficiency and evidence in the well-child care
prevention programme.
•Work with family doctors and GP using U.S.
Preventive Services Task Force (USPSTF) 2012
•
•Belong to EUROPREV (European Network for
Prevention and Health Promotion) oficial WONCA
network
Electronic records
Does your practice / your country have electronic
records of the results?
YES
Are they evaluated?
YES
Is there a public registry?
No, but Primary Care Pediatricians (PCP) are
informed about data results
Which provider is entitled to
perform the well-child care visits?
Nurses/pediatric nurses
Primary Care Pediatricians
Midwife/GP prenatal visits
PCP always prefer specialized pediatric
nurses but unfortunately this is seldom
possible due to political reasons
Estimated percentage of the PCPs worktime dedicated to preventive paediatric
health care of all his work- time?
15-30%
Are visits to well-child care compulsory? NO
Enforced by law? NO
Are vaccinations compulsory? NO
What happens in case of non- participation?
The family is given a phone call, usually by
the nurse
Is participation in well-child care and/or
vaccination necessary for enrollment to
kindergarden or school? The school
requests a certificate of vaccines. As
vaccination is not mandatory, if family does
not provide the vaccines certificate, school
cannot deny access.
Which sensory vision screenings
are performed?
•
•
•
•
Red reflex in newborns and toddlers
Screening of strabismus conditions:
Cover/uncover test and Hirschberg test
from 6 months visit
Detecting amblyopia with TNO test for
stereoscopic vision at 4 years old visit
Vision screening charts beginning at 4
years old visit to determine visual
acuity and look for refractive errors and
colour deficiencies in each visit
Which hearing screenings are performed?
Universal newborn hearing screening
by Otoacoustic Emissions (OAEs) or
auditory brainstem response (ABR)
before newborn discharge from
public and private hospitals
In each visit we inquire parents
about normal hearing and language
skills
Which hip dysplasia screening is
performed?
Ultrasound only in children with agreed
risk factors
Barlow Ortolani Galeazzi maneuvers
and leg length discrepancy in all
toddlers well child visits
Which other screenings are performed?
(laboratory tests, urine testing, TB testing,
etc)
There are NO
universal laboratory screening
tests in well child care visits in
Spain
Have paediatricians undergone some
competency based training for well
child care visits so that their performance
is somehow comparable?
YES, three months
compulsory learning with a
PCP in public health centers
How do migrants /asylum seekers/ refugees
participate regularly in well-child care and
vaccinations? In Spain all children under 18
years are entitled to free medical care, even
if they have no legal documents.
They all have mínimun partial (40%) or total
non refundable aid for medication.
Are there barriers to access fully the health
system? NO
•
•
•
•
What are your ideas to improve
preventive pediatric health care in
your country / in Europe?
To promote the specialty of pediatric
primary care nurse
To promote the specialty of Primary
Care Pediatrician
To increase PCP visibility in
universities
To increase the pediatric residents
rotation period in primary care
settlements
¿What should ECPCP do in order to
promote preventive pediatric health
care?
• Upload and publish Yona Amitai’s
extensive document compiled a
few years ago on the ECPCP web
• Unify all these PPT in one unique
document and publish it as a
reference