[New challenges for the general pediatrician: high technology applied to the patients]

New technologies are concentrated and managed in large urban centers at highly developed hospitals. These technologies reach primary health care (HC) level through a "sui generis" intra-national transfer of technology: incorporated to patients. Patients with continuous ambulatory peritoneal dialysis (CAPD) are emblematic of this model of technological transfer. One patient with CAPD is taken as case study for analysis and discussion about problems in HC primary level. The lack of an adequate and efficient primary health care develops a quasi vital dependence on distant hospitals. As a consequence, primary pediatricians are limited to routine and bureaucratic activities to comply with tertiary level staff prescriptions. The outcome is negatif both for patients and health professionals i.e. strict dependence with HC tertiary level, high amount of unnecessary hospitalizations, severe interference with patients and their family social life, frustration, fear, insecurity and potential progressive difficulties in the access to health care. Real participation of all levels of HC staff constitute a sine que non necessity for the attaining of patients rehabilitation through family-centered, community-based care and for equity in the access to HC facilities. The reaching of these goals requires primary pediatricians to become involved in a program of continuous training education on new technologies tailored to their needs, possibilities and wishes if a comprehensive coordination between primary and tertiary health care levels is to be expected.