Ni Bhrolchain C M
Royal Liverpool Children's NHS Trust, Royal Liverpool Children's Hospital.
Public Health. 1994 Sep;108(5):319-26. doi: 10.1016/s0033-3506(05)80067-8.
Community paediatricians have traditionally provided primary preventive services. The new GP Contract encourages GPs to provide such services within practices but practices in deprived areas may be less able to do so than more affluent practices. This paper attempts to analyse the role of a community paediatrician in a deprived area of South Sefton (Merseyside) HA in providing primary care both before and after the new contract, and the effect the contract had on the involvement of GPs in preventive health care. Only 20% of immunisations and 5% of child health surveillance (CHS) were done within practices in 1989. This rose to 34% and 16% respectively by 1991, but community clinic attendances also rose by 26%. Immunisation uptake improved from DT & Polio 77%, Pertussis 51% and Measles 37% to 98%, 87% and 98% over five years. The identification of problems before school entry was poor, but improved from 31% to 51% over three years. Most problems were identified by professionals during CHS and school health checks rather than being presented by parents. Increased recognition led to an increased need for 'secondary level' support and follow-up of problems. The GPs in this area needed the support of a community paediatrician to provide comprehensive preventive health care. Such areas may need to explore alternative models of care to meet child health needs.
传统上，社区儿科医生提供初级预防服务。新的全科医生合同鼓励全科医生在诊所内提供此类服务，但贫困地区的诊所可能比富裕地区的诊所更难做到这一点。本文试图分析南塞夫顿（默西塞德郡）健康管理局一个贫困地区的社区儿科医生在新合同签订前后提供初级保健方面的作用，以及该合同对全科医生参与预防性医疗保健的影响。1989年，只有20%的免疫接种和5%的儿童健康监测（CHS）在诊所内进行。到1991年，这一比例分别上升到34%和16%，但社区诊所的就诊人数也增加了26%。在五年时间里，白喉、破伤风和脊髓灰质炎疫苗接种率从77%提高到98%，百日咳疫苗接种率从51%提高到87%，麻疹疫苗接种率从37%提高到98%。入学前问题的识别情况较差，但在三年时间里从31%提高到了51%。大多数问题是专业人员在儿童健康监测和学校健康检查期间发现的，而不是由家长提出的。识别率的提高导致对“二级”问题支持和跟进的需求增加。该地区的全科医生需要社区儿科医生的支持来提供全面的预防性医疗保健。这些地区可能需要探索替代的护理模式以满足儿童健康需求。
