A 10-nation study examines how the provision of pediatric developmental services is apportioned among different types of health care providers— pediatricians, general practice physicians, and nurses. In doing so, the researchers shed light on the uniquely broad role that U.S. pediatricians play in delivering child health care.
- Of the 10 countries studied—Australia, Canada, Denmark, England, France, Germany, Japan, the Netherlands, Spain, and Sweden—most divide responsibility for primary care developmental services among more than one type of health professional (e.g., pediatrician, general practice physician, nurse) and setting (e.g., medical group practice, multidisciplinary community center).
- In six of the 10 countries, the monitoring of young children’s development is primarily the responsibility of nurses working in geographically based community centers.
- In most of the countries, nurses are responsible for anticipatory guidance and parent education, as well as for developmental counseling for particular problems, such as tantrums.
- Care coordination and referral can be the responsibility of different health care providers in the various countries, but follow-up and care coordination for more specialized developmental services, such as early intervention, are usually the responsibility of a general practice physician or pediatrician.
Addressing the Problem
In the United States, pediatricians are primarily responsible for all child health services—acute care, developmental monitoring, health supervision, referral, and care coordination. But many other industrialized nations divide responsibility among health care professionals, with pediatricians focusing on providing specialized developmental care for children with identified problems, as well as managing chronic conditions. In some cases, a national maternal and child health care infrastructure also carries some of the burden. To improve outcomes in the U.S., we face a choice between building more support around the pediatrician-focused medical home model and dividing responsibility for services among providers, say the authors.
About the Study
The study team performed structured interviews with 20 child health care experts in 10 countries: Australia, Canada, Denmark, England, France, Germany, Japan, the Netherlands, Spain, and Sweden. Participants were asked to respond to four scenarios representing common diagnostic and treatment issues in pediatric developmental health.
The Bottom Line
Involving nurses, general practitioners, and other clinicians in the delivery of developmental services might enable children in the United States to receive more thorough and effective care.