Kahan Ernesto, Gross Samuel, Horev Zeev, Grosman Zahi, Cohen Herman Avner
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Patient Educ Couns. 2006 Feb;60(2):164-70. doi: 10.1016/j.pec.2004.12.010. Epub 2005 Oct 26.
The exclusion of ill children from child-care centers may be associated with high social, economic and medical costs.
To assess the opinions of pediatricians working in an outpatient setting in Israel on the exclusion/return of children in child-care centers.
A questionnaire on practices of exclusion/return of children in child-care centers, in general and according to specific signs and symptoms, was administered to a random computer-selected cross-sectional sample of 192 primary care community pediatricians in Israel.
One hundred and seventy-three pediatricians completed the questionnaires, for a response rate of 90%; 147 were board-certified and 26 were not. About half the pediatricians felt pressured by parents requesting antibiotic therapy to accelerate the return of their sick child to the child-care center. The majority also believed their practice was overloaded by often unnecessary demands for medical notes by the child-care centers before children could return. More than half based their decision to exclude children on "common sense" and the remainder, on accepted guidelines. Except for scabies and lice, there were no significant correlations between the physicians' stipulation for a note on return of the child and the specific illness guidelines.
This study shows that a high proportion of pediatricians based their exclusion practices on "common sense" and personal understanding instead of established guidelines, and that the guidelines did not affect their opinion on the duration of illness that warrant a note. Furthermore, half were subjected to parental pressure to employ inappropriate practices. These findings, combined with our earlier survey of child-care centers staff, indicate that better education of parents and day-care staff about ill child-care-center-exclusion policy in Israel would increase their common understanding with pediatricians.
将患病儿童排除在日托中心之外可能会带来高昂的社会、经济和医疗成本。
评估在以色列门诊工作的儿科医生对于日托中心儿童排除/返回的看法。
向以色列192名基层医疗社区儿科医生的随机计算机选择横断面样本发放一份关于日托中心儿童排除/返回做法的问卷，问卷涉及一般情况以及根据特定体征和症状的情况。
173名儿科医生完成了问卷，回复率为90%；147名具有专业认证，26名没有。约一半的儿科医生感到有压力，因为家长要求使用抗生素治疗以加速患病孩子返回日托中心。大多数人还认为，在孩子返回之前，日托中心经常提出不必要的医疗证明要求，这使他们的工作负担过重。超过一半的人根据“常识”做出排除儿童的决定，其余的人则依据公认的指南。除了疥疮和虱子，医生对孩子返回所需证明的规定与具体疾病指南之间没有显著相关性。
本研究表明，很大一部分儿科医生基于“常识”和个人理解而非既定指南来进行排除操作，并且这些指南并未影响他们对需要开具证明的疾病持续时间的看法。此外，一半的医生受到家长压力而采取不当做法。这些发现，结合我们早期对日托中心工作人员的调查，表明在以色列更好地对家长和日托工作人员进行关于患病儿童排除在日托中心政策的教育，将增进他们与儿科医生的共同理解。
