Stein-Zamir Chen, Shoob Hannah, Zimmerman Deena R
Jerusalem District Health Office, Ministry of Health, 86 Jaffa Road, 94341, Jerusalem, Israel.
Braun School of Public Health and Community Medicine, Faculty of medicine, the Hebrew University of Jerusalem, Ein Kerem. PO Box 12272, 91120, Jerusalem, Israel.
Isr J Health Policy Res. 2017 Oct 2;6(1):53. doi: 10.1186/s13584-017-0174-z.
Preventative health services are a pediatric health care cornerstone, which strives to promote health and prevent illness and injury. In Israel, Maternal Child Health Clinics (MCHC) provide these well child services for ages 0-6 years. MCHC care includes physician visits; however, the physician's role is not well defined. The study purpose was to provide a basis for setting policies that determine the role of physicians in the provision of MCHC services. To get broad input we included MCHC stakeholders - parents, MCHC physicians, non-MCHC physicians and MCHC nurses, specifically to obtain insights regarding the MCHC physician role and to characterize the stakeholder demographics, service utilization, and practice patterns.
Professional groups completed self-administered written questionnaires (n = 398). Parents were interviewed during MCHC visits using a structured questionnaire (n = 1052). All provided demographic data, service characteristics and agreement with ten potential MCHC physician roles - Physical Examination, Abnormal Health Condition Detection, Developmental Screening, Anticipatory Guidance, Parent-Child Interaction Counseling, MCHC Staff Advice, Children-at-Risk Detection, Growth Surveillance, Vaccination Counseling, and Inter-physician Communication.
The study findings seem to indicate a true shortage of MCHC physicians. The median age of MCHC physicians was significantly higher than both non-MCHC physicians and MCHC nurses. There was agreement among stakeholders regarding some roles (Physical Examination, Developmental Screening and Detection of Abnormal Health Conditions) but not others. Most parents reported having at least one MCHC physician encounter. Parents who did not visit the physician were younger and had fewer children.
Stakeholders view MCHC physicians as integral to MCHC care. Roles traditionally regarded as part of primary prevention were less likely to be attributed to physicians than screening roles considered secondary prevention. Updating and standardization of the MCHC physician role is needed along with a national strategy to recruit and train MCHC physicians.to ensure optimal pediatric preventive health care in Israel.
预防性健康服务是儿科医疗保健的基石，致力于促进健康、预防疾病和伤害。在以色列，母婴健康诊所（MCHC）为0至6岁儿童提供这些健康儿童服务。MCHC护理包括医生问诊；然而，医生的角色并未明确界定。本研究的目的是为制定确定医生在提供MCHC服务中角色的政策提供依据。为了获得广泛的意见，我们纳入了MCHC的利益相关者——家长、MCHC医生、非MCHC医生和MCHC护士，特别是为了获取有关MCHC医生角色的见解，并描述利益相关者的人口统计学特征、服务利用情况和实践模式。
专业群体完成了自我管理的书面问卷（n = 398）。在MCHC就诊期间，使用结构化问卷对家长进行了访谈（n = 1052）。所有人都提供了人口统计学数据、服务特征以及对MCHC医生的十个潜在角色的认同情况——体格检查、异常健康状况检测、发育筛查、预期指导、亲子互动咨询、MCHC工作人员建议、高危儿童检测、生长监测、疫苗接种咨询和医生间沟通。
研究结果似乎表明MCHC医生确实短缺。MCHC医生的年龄中位数显著高于非MCHC医生和MCHC护士。利益相关者对某些角色（体格检查、发育筛查和异常健康状况检测）达成了共识，但对其他角色则没有。大多数家长报告至少有一次与MCHC医生接触。未就诊的家长更年轻且子女较少。
利益相关者认为MCHC医生是MCHC护理不可或缺的一部分。传统上被视为一级预防一部分的角色比被视为二级预防的筛查角色更不太可能归因于医生。需要更新和规范MCHC医生的角色，并制定一项招募和培训MCHC医生的国家战略，以确保以色列的儿科预防性医疗保健达到最佳水平。
