Paediatricians provide higher quality care to children and adolescents in primary care: A systematic review

Abstract

Aim The number of primary care paediatricians is decreasing in Europe without a justifiable reason. We aimed to compare the clinical practice of paediatricians and family doctors attending children and adolescents in primary care. Methods MEDLINE, Embase, CENTRAL, TRIP and Google Scholar were searched from December 2008 to February 2018. No language or study design restrictions were applied. Three reviewers assessed eligibility of the studies. Seven pairs of reviewers performed the data extraction and assessed the methodological quality independently. Discrepancies were resolved by consensus. Results Fifty‐four, out of 1150 studies preselected, were included. We found that paediatricians show more appropriate pharmacology prescription patterns for the illness being treated; they achieve higher vaccination rates and have better knowledge of vaccines and fewer doubts about vaccine safety; their knowledge and implementation of different screening tests are better; they prescribe psychoactive drugs more cautiously and more in line with current practice guidelines; their evaluation and treatment of obesity and lipid disorders follow criteria more consistently with current clinical practice guidelines; and they perform fewer diagnostic test, show a more suitable use of the test and request fewer referrals to specialists. Conclusion According to published data, in developed countries, paediatricians provide higher quality care to children than family doctors.

The Role of Pediatricians in Providing Greater-Quality Care for Children: An Ongoing Debate

“…Although the heterogeneity of the studies did not allow for a rigorous meta-analysis, the data showed that in 62.5% of the studies antibiotic prescription by pediatricians was reported to be more appropriate and in line with official clinical practice guidelines. 21,27…”

“…The systematic AEPap review indicates that pediatricians were more accurate than generalists in assessing the nutritional status of children and adolescents and in following the guidelines for diagnostic procedures and preventive programs for these conditions. 21,27,28 Finally, the review reports that pediatricians were more diligent than GPs or other specialists in areas of clinical practice, such as the use of laboratory tests in the diagnosis and management of different conditions (streptococcal, celiac disease, diabetes mellitus, and early diagnosis of acute lymphoblastic leukemia), and referring to specialists for the pharmacologic treatment of psychiatric disorders. 27…”