The Future Pediatrician: The Challenge of Chronic Illness
Section snippets
The Changing Epidemiology of Childhood
Pediatric practice must, at some level, respond to the underlying epidemiology of children’s health needs. Accordingly, we must explore the extent to which the power and cadence of clinical innovation has so altered the epidemiology of child health that it will require changing the way in which child health services are provided in the United States, and ask who will effect these changes.
Interestingly, there has been little change in the incidence of acute illness among children in the United
The Dichotomization of Child Health: Implications for Pediatric Practice
Taken together, the aforementioned morbidity and mortality trends suggest that as rates of hospitalization and death in children have declined, hospitalization and death have become increasingly more concentrated in children with chronic illness. These trends also suggest that the vast majority of children without a chronic disorder are increasingly unlikely to experience a serious illness. This effect is likely to intensify as new vaccines for gastrointestinal and respiratory infections are
The Emerging Impact of Dichotomization
If pediatric practice must reflect the epidemiology of childhood illness, then risk dichotomization ultimately will be expressed as practice dichotomization. Despite major efforts to highlight the importance of the “medical home” as an approach to coordinating care for children with special health care needs,23 most pediatricians report that they spend only 1 hour or less per week coordinating such care24 and cannot schedule more time for such patients, and also do not have the necessary
Shaping a Pediatric Community Response
The basic conclusion of this discussion is that the traditional structure of pediatric practice in the United States is not likely to be sustainable in the years to come. The epidemiology is shifting to chronic disorders at the same time that it is becoming more difficult for traditionally organized primary care pediatrics to respond. Current financial and practice incentives will continue to emphasize high-volume care for generally well children, whereas growing cost pressures will make it
The Present Opportunity
The arguments presented here are intended to provoke constructive discussion and, ultimately, meaningful action. The hope is that the strong leadership the pediatric community has shown on various health issues can be turned to the challenges confronting pediatrics itself. Without such leadership, there is a danger that the pediatric community’s own fears, defensive impulses, and fragmented constituencies could immobilize it in ways that would be self-marginalizing, relegating its role to that
References (38)
- et al.
Comparing different definitions of chronic conditions in a national data set
Ambul Pediatr
(2002) - et al.
Will current training programs prepare pediatricians to meet the health care needs of children in the 21st century?An opinion
J Pediatr
(2001) The transformation of child health in the United States
Health Affairs
(2004)- et al.
Changes in the daily practice of primary care for children
Arch Pediatr Adolesc Med
(1998) - et al.
Prevalence and impact of disabling chronic conditions in childhood
Am J Public Health
(1998) - National Center for Health Statistics. 2005 National Health Interview Survey public use data release: NHIS survey...
Surveillance for asthma—United States, 1980-1999
MMWR Morb Mortal Wkly Rep
(2002)- et al.
Summary health statistics for US children: National Health Interview Survey, 2005
Vital Health Stat
(2006) - et al.
Prevalence and trends in overweight among US children and adolescents, 1999-2000
JAMA
(2002) - et al.
Racial and ethnic differences in secular trends for childhood BMI, weight, and height
Obesity
(2006)