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Management of problems related to the new morbidity by community-based paediatricians in Israel
K Oren1, I Shoham-Vardi, B Reichman
1Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Insights
Community paediatricians are less active in managing new morbidity (NM) issues compared to classic paediatric problems. Factors like practice location and collaboration influence their engagement in NM care.
Area of Science:
- Pediatrics
- Community Health
- Healthcare Management
Background:
- The rise of new morbidity (NM) conditions, including chronic diseases and developmental/behavioral issues, presents unique challenges for community-based paediatricians.
- Understanding how paediatricians manage these complex cases is crucial for optimizing child healthcare delivery.
Purpose of the Study:
- To evaluate the management approaches of community-based paediatricians towards new morbidity (NM) clinical situations.
- To identify factors associated with paediatricians' engagement in managing NM problems.
Main Methods:
- A self-administered questionnaire was used, featuring 20 clinical vignettes (14 NM, 6 classic paediatrics).
- The study included 574 community-based paediatricians from Israel's largest health maintenance organizations, with a 74% response rate.
- Physicians reported their intended management strategies and perceived roles for each scenario.
Main Results:
- Paediatricians demonstrated significantly less active management of NM-related problems (68.3%) compared to classic paediatrics (93.2%).
- Perceived role significantly predicted active management; when paediatricians viewed NM as their responsibility, they were more likely to manage it actively.
- Key factors predicting active NM management included practicing in peripheral areas, consulting with non-medical professionals, and combining community and hospital practice.
Conclusions:
- Enhancing paediatricians' involvement in new morbidity care requires a multifaceted approach.
- Modifications in paediatric residency training, practice environments, and the perceived role of paediatricians are essential for comprehensive care.
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.
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