Symposium on the practice and the evidence of prevention in

pediatric primary care

ECPCP meeting Praguenov. 2015

WELL-CHILD CARE VISITS

Prenatal phase

Infancy first 11 m

1-4 years

5-10 years

11-18years

TotalVisit

Prenatal and

Well child care

4-8 5-6 3 2 317-22Visits

Well child care

5-6 3 2 313-14Visits

Age dependent coverage, results, cost- efficiency, evidence?

• Our association has a national work group called Previnfad that investigates and publishes about cost-efficiency 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 visitsPCP always prefer specialized pediatric nurses but unfortunately this is seldom

possible due to political reasons

Estimated percentage of the PCPs work- time dedicated to preventive paediatric

health care of all his work- time?

15-30%

Are visits to well-child care compulsory? NOEnforced 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