ChildHealthinthe21stCenturyTheRoleofthePaediatricianinanInterProfessionalEnvironment

Child Health in the 21st Century The Role of the Paediatrician in an Inter-Professional Environment

Article

Executive Summary & Reflections on the Symposium

Jonathan B. Kronick, Dalhousie University/IWK Health Centre, Halifax, NS
Canada's infants, children and youth must receive the very best health care possible and, therefore, it is essential that their care providers have the appropriate education and training to meet future needs. While many providers are involved in the delivery of health care, pediatricians have played and will continue to play a significant and essential role in the provision of health care services to infants, children and youth. It is critical that the skills, competencies and roles required by pediatricians to optimally deliver health care to Canada's infants, children and youth be well defined and needs-based especially as child health care and the health care system continues to evolve rapidly. These changes include inter-professional practice, collaborative care models, the increasing number of accredited subspecialties and their impact on the role of the pediatrician, hospitalists, more varied communities of practice, and so on. It is necessary to effectively determine the future health care service needs of Canada's infants, children and youth, and identify the competencies that pediatricians must have to play an appropriate role in the delivery of child health care. Therefore the symposium, Child Health in the 21st Century: The Role of the Pediatrician in an Inter-Professional Environment was convened on November 17, 18, 2006. This invitational multidisciplinary symposium addressed and defined the attributes including the knowledge, skills, competencies and roles that Canada's pediatricians need to deliver health care to Canada's infants, children and youth in the future.
The Canadian Pediatric Society (CPS), the Paediatric Chairs of Canada (PCC), and the Canadian Association of Paediatric Health Centres (CAPHC) were the original sponsors of the symposium. Subsequently Health Canada, the Public Health Agency of Canada, and The Society of Obstetricians and Gynaecologists of Canada became official sponsors of the symposium.

Objectives

• The primary objective was to identify the future roles of the pediatrician in the delivery of health care to Canada's children and youth in the context of the evolving inter-professional environment. This includes identifying the knowledge, skills and competencies that pediatricians must have, and the roles that pediatricians must play as generalists, subspecialists, community-based practitioners, academic practitioners, investigators acquiring new knowledge pertinent to child and youth health, advocates, and partners with education and public health institutions.

• A secondary objective was to consider human resource needs, i.e. the number of pediatricians, as well as of other health professionals, who will be required for the various roles in the context of the evolving inter-professional health care system, while recognizing the necessity to optimize the use of all resources.

To address these objectives, input was required from many stakeholders who are directly or indirectly involved in child health. Symposium delegates came from coast to coast and represented a wide variety of communities and health professions, including the College of Family Physicians of Canada (CFPC), the Royal College of Physicians and Surgeons of Canada (RCPSC), educational institutions, medical educators, the Public Health Agency of Canada, the Health Council of Canada, nursing organizations, psychiatrists, and psychologists, families, and governments. The symposium planning committee included representatives from the CPS, PCC, CAPHC, the Pediatric Undergraduate Program Directors, the Association of Canadian Pediatric Program Directors, the Chair of the RCPSC Pediatric Specialty Committee, CFPC, representatives from the Public Health Agency, Health Canada, the Canadian Family Advisory Network, and the Canadian Nurses Association (CNA).

Symposium Outline

The Keynote speaker was Dr. Brian Postl, CEO of the Winnipeg Health Authority and National Wait Time Advisor.

The symposium was organized into four themes:

1. Meeting the Needs of Diverse and/or Vulnerable Populations;
2. Meeting the Needs of Infants, Children and Youth with Chronic Health Conditions;
3. Infant, Child and Youth Health Human Resources; and
4. Education and Training: Meeting the Needs of Infants, Children and Youth

Each theme began with a plenary session delivered by experts from across the country and was followed by breakout groups which tackled challenging issues emerging from the plenary. Each breakout group summarized its deliberations and reported back to the entire conference. A multidisciplinary Panel Discussion addressed Inter-Professional Care Models.
The final afternoon of the symposium was devoted to developing recommendations and next steps. The symposium Recommendations are detailed in the final section of these proceedings and represent the most important outcome of the symposium. For the symposium to really be a success, however, the recommendations must lead to action and measurable outcomes. The recommendations addressed four broad areas:

• Promoting the best healthcare services for all Canadian infants, children and youth.
• Addressing the health needs of vulnerable populations including, but not limited to aboriginal, impoverished, immigrant, disabled, and maltreated infants children and youth.
• Improving access to mental healthcare services for infants, children and youth.
• Improving healthcare through interdisciplinary cooperation and collaboration.

Each of these areas included recommendations addressing advocacy, education, care delivery and research.

Reflections from the Symposium Chair

While the symposium dealt with many issues summarized in these proceedings, as symposium chair I would like to highlight the issues which resonated for me and stood out as especially noteworthy. While many aspects of the delivery of child health services and the care provided by paediatricians are effective and were cited during the symposium, the gaps and the unmet needs are the areas to which I draw the reader's attention:

• Communication with parents: Parents play an essential and too often underappreciated role in the organization, management and delivery of their child's care. In addition, and even more important, is the absolute necessity of providers to communicate effectively, openly, and repeatedly with parents to ensure that true collaboration and partnership with parents takes place in the care delivery for their children. We heard often, and with great eloquence, how parents of children with chronic illness too often feel marginalized and undervalued in the care of their children.

• The problems with fee for service remuneration: Fee for service remuneration was often cited as a barrier to providing optimal care to infants, children and youth, especially those with behavioural, mental health or chronic illnesses. Acute care appears to be better supported by current fee for service systems but for more chronic situations, both with medical and mental health challenges, alternate methods of remuneration are urgently needed to facilitate care of these patients and their families. Likewise, the repeatedly voiced importance of inter-professional care - which appears to be appropriate for these populations - is often undermined rather than supported by fee for service.

• Improving medical education: The child health-directed education of medical students, pediatric residents and family medicine residents clearly needs more focus on mental health, vulnerable populations, inter-professional models of care, public health, cultural diversity, social determinants of health, advocacy, and prevention.

• Need for more inter-professional care delivery: While pediatricians are and will remain an essential component of the care of infants, children and youth, other health care professionals will take on increasing importance in the provision of this care as the number of working pediatricians cannot now and will in the future be even less able to meet all the needs. This is yet another reason to foster more inter-professional models of care for infants, children and youth

• Unmet needs of vulnerable populations: Sadly, many vulnerable populations of infants, children and youth either do not yet have appropriate access to care or are otherwise not receiving optimal care. These populations include many children and youth living in rural or remote locations, aboriginal and immigrant children, as well as those with many chronic disorders or mental illness. These unmet needs pose an important challenge that Canada's pediatricians and other health care providers must urgently address together. Having said that, governments, as well as many other institutions, will have to be part of the solutions to these pressing health care discrepancies.

• The need for advocacy: It was repeatedly stressed that pediatricians need to advocate not only on behalf of their own patients but on behalf of their communities and for system and societal improvements since many factors, directly and indirectly, affect children's health and well being. Indeed if there were to be only one recommendation from this symposium it might be to advocate, advocate and advocate.

• The need for more child health care providers: Finally, although not the primary focus of the symposium, there are clearly many unmet health needs of infants, children and youth which have led many to suggest that there are an insufficient number of pediatricians and other health care providers who care for infants, children and youth. It is expected that this problem will become more serious in the future. This will present an enormous challenge especially considering the primarily adult-focused Canadian health care system. In our child health advocacy roles, we must not forget the need for sufficient numbers of paediatricians and other health care providers who focus on child health and an appropriate distribution of these professionals. Careful planning, based on evidence, will be crucial to address these challenges.

Symposium Sponsors

The generous financial and in-kind support of the symposium sponsors is greatly appreciated. This symposium could not have taken place without the sponsors' support and of course the participation of the delegates, keynote speaker and the many expert presenters.

• Canadian Association of Paediatric Health Centres
• Canadian Paediatric Society
• Health Canada
• Paediatric Chairs of Canada
• The Society of Obstetricians and Gynaecologists of Canada

Ongoing Activities

The Child Health in the 21st Century Steering Committee is continuing to develop resources related to the role of paediatricians, and other health professionals, in the health system.  Building on the Goals, and Recommendations found in this report, the Steering Committee is identifying resources that support or contribute to the goals identified herein.

• A "Road Map" of these efforts can be found at:  http://www.mindmeister.com/16735213/child-health-in-the-21st-century

and 
 

• A  website of resources can be found at:  http://childhealth21.caphc.org

For More Information

To read the full document, click here to open the attached PDF

For more information on this initiative contact CAPHC at 613-738-4164.

Topic

Other

Sub Topic

General Information 

Description

Canadian Association of Paediatric Health Centres
dmaynard@caphc.org