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Cine y Pediatría 8
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What medical professional is the most adequate, in developed countries, to provide health care to children in primary care? Systematic review


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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.


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