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The involvement of community pediatricians in the treatment of developmental-behavioral difficulties as perceived by directors of child development centers. Isr J Health Policy Res 2021; 10:56. [PMID: 34663448 PMCID: PMC8521281 DOI: 10.1186/s13584-021-00492-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background Developmental-behavioral issues are among the most frequent and disabling conditions of children and adolescents seen in ambulatory settings. Guidelines of the Israeli Pediatric Association and the Israeli Society for Developmental Pediatrics specify the role of the primary-care pediatrician in screening and early identification of mild developmental behavioral conditions and define the criteria for referral to child development institutes. The aims of this study were to examine and describe how directors of these institutes perceive the role and involvement of community pediatricians in child development. Methods Qualitative interviews of the directors of 22 child development institutes from the ministry of health and the four health plans. Results According to the interviewees, there is little involvement of community pediatricians in detecting developmental delays, and it is mainly nurses and preschool teachers who detect such delays. They report that the key barriers that deter community pediatricians from greater involvement in child development diagnosis and treatment are lack of time, lack of compensation, and insufficient clinical knowledge. The interviewees would like to see community pediatricians conducting the primary medical evaluation, providing parental guidance, referring to therapists in mild cases, exercising discretion before referring children to child development institutes and providing relevant information to the institutes in the referral process. The mechanisms that they proposed for increasing the involvement of community pediatricians were expansion of pediatricians’ training, increased pediatricians’ use of teleconsultation with child development specialists and incentives for thorough performance of developmental assessments. Conclusions Due to the importance of the Issue, we strongly recommend that policymakers require child development principles, evaluation, and providing appropriate parental guidance in the curriculum of the Israeli pediatric residency program. In addition, health plans should compensate pediatricians who need to conduct longer visits for children with developmental delays. The health plans should also develop teleconsultation channels for pediatricians with child development specialists to reduce unnecessary referrals to child development institutes.
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Tokatly Latzer I, Grossman Z, Sachs N, Yahal O, Even-Zohar D, Carmon L, Flor-Hirsch H, Ringel A, Farah CF, Avni-Maskit M, Leitner Y. Failure of Israeli pediatric residency curricula to cover child development and special education issues: results of a national survey on levels of knowledge. Isr J Health Policy Res 2021; 10:45. [PMID: 34544489 PMCID: PMC8454173 DOI: 10.1186/s13584-021-00480-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022] Open
Abstract
Background There is an increasing prevalence of developmental difficulties among Israeli children. We aimed to assess whether pediatricians are equipped to diagnose and manage them. Methods We assessed the knowledge of basic child development issues and availability of services and content of special education systems among a randomly selected national sample of residents and senior Israeli pediatricians. This was done via an 70-itemed survey developed especially for this study which consisted of seven main subjects: developmental milestones, global developmental delay, autism spectrum disorder, attention deficit hyperactivity disorder, protocol for referring to a child development institute, availability and facilities of special education systems, and medical conditions associated with developmental delay. Results A total of 310 pediatricians (an 86 % usable response rate) participated. The total median knowledge score was 32.1 % (IQR 17.8–53.5 %). Knowledge was significantly better among senior pediatricians (p < .001), those working in an office-based setting (p < .001), and those who were parents (p < .001) or had a family history of a developmental condition (p = .003). Most responders (94 %) felt that their resident training in child development was inadequate, and that they do not have sufficient access to resources and guidelines about child development and special education systems (80 %). Conclusions The gap in knowledge on topics of child development and special education systems among Israeli pediatricians stems from inadequacies in the current curricula of pediatric residencies. The alarmingly low scores of our survey on these issues call for prompt revamping of the syllabus to include them. Supplementary Information The online version contains supplementary material available at 10.1186/s13584-021-00480-y.
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Affiliation(s)
- Itay Tokatly Latzer
- Child Development Institute, The Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Zachi Grossman
- Pediatric Clinic, Maccabi Healthcare Services, Tel Aviv, Israel.,Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Nimrod Sachs
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics C, Schneider Children's Hospital, Rabin Medical Center, Petach Tikvah, Israel
| | - Orr Yahal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics A, Edmond and Lilly Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Daniel Even-Zohar
- Department of Pediatrics, Hadassah Medical Center, Jerusalem, Israel
| | - Lior Carmon
- Department of Pediatrics, Faculty of Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | - Hadar Flor-Hirsch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Neurology Unit, Assaf Harofeh Medical Center, Rishon Lezion, Israel
| | - Amit Ringel
- Department of Pediatrics, Kaplan Medical Center, Rehovot, Israel
| | - Christopher Fady Farah
- Department of Pediatrics, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | - Yael Leitner
- Child Development Institute, The Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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