Municipal Health Service Gelderland-Midden, Arnhem, Netherlands; Netherlands Organisation of Applied Scientific Research, Leiden, Netherlands;
Netherlands Organisation of Applied Scientific Research, Leiden, Netherlands;
Pediatrics. 2016 Mar;137(3):e20150814. doi: 10.1542/peds.2015-0814. Epub 2016 Feb 8.
We investigated the detection of health problems in preventive child health care (PCH) by a novel triage approach for routine health assessments. In the triage approach, all children were preassessed by a physician's assistant, and only those in need of follow-up were assessed by a PCH physician or nurse. In the traditional approach, all children were assessed by a PCH physician or nurse.
A prospective cohort design was used with data on routine assessments of 1897 children aged 5 to 6 and 10 to 11 years. Primary outcomes were the detection of overweight, visual disorders, and psychosocial problems, with type of approach (traditional vs triage) as independent variable. To assess the severity of health problems, BMI, Snellen, Strengths and Difficulties Questionnaire, and Child Behavior Checklist, scores were compared for both approaches in subgroups of children with overweight, visual disorders, or psychosocial problems.
No significant differences were found between the approaches in terms of the detection of incident cases of overweight, visual disorders, and psychosocial problems. Significantly higher Strengths and Difficulties Questionnaire scores were found in the subgroup with psychosocial problems when the triage approach was used. Marginal differences between the approaches were found for severity of overweight in the subgroup of overweight children.
A novel triage approach to PCH resulting in less involvement of physicians and nurses in routine assessments appears to detect health problems as effectively as the traditional approach in place. More research is needed to determine the long-term outcomes of the 2 approaches.
我们研究了通过一种新的分诊方法在预防儿童保健（PCH）中检测健康问题。在分诊方法中，所有儿童都由医生助理进行初步评估，只有需要随访的儿童才由 PCH 医生或护士进行评估。在传统方法中，所有儿童都由 PCH 医生或护士进行评估。
采用前瞻性队列设计，对 1897 名 5 至 6 岁和 10 至 11 岁儿童的常规评估数据进行分析。主要结局是检测超重、视觉障碍和心理社会问题，以方法类型（传统与分诊）为自变量。为了评估健康问题的严重程度，在超重、视觉障碍或心理社会问题的儿童亚组中，比较了 BMI、Snellen、Strengths and Difficulties Questionnaire 和 Child Behavior Checklist 分数在两种方法中的差异。
在检测超重、视觉障碍和心理社会问题的新发病例方面，两种方法之间没有显著差异。在使用分诊方法的心理社会问题亚组中，Strengths and Difficulties Questionnaire 得分显著更高。在超重儿童亚组中，两种方法在超重严重程度方面存在边际差异。
一种新的分诊方法用于 PCH，使医生和护士较少参与常规评估，似乎与现有的传统方法一样有效地检测健康问题。需要进一步研究以确定两种方法的长期结局。
