ECPCP meeting: Slovenia Tina Bregant, Mateja Vintar Spreitzer, Margareta Seher Zupancic Vienna, 5.5.2017

Slovenia – basic data Live births between 2005 and 2014

Organisation of PC Provision of preventative care – systematic, routine health visits at regular intervals: -Growth parameters, clinical medicine -Developmental (+ behavioural) issues (Denver-II) -Vaccination -Safety and general health advice -Interaction with the nursery, kindergarten, school and community programs Assurance of ambulatory care at any time: -Diagnostics -Basic and emergency treatment -Further referral to other subspecialist, hospital specialists Continuity of care (from birth to adulthood) Record keeping data base Research?! Education?! Assurance of secondary, tertiaty care at any time: -Diagnostics -All available treatment -Further referral to other subspecialist, consultation if needed Provision of medical guidelines (specific, not always compatible with ambulatory care!) Research & publication Medical education (graduate, potgraduate, MD + other health programmes) Central record keeping data base

Slovenia - paediatricians In hospital: 267 (1) In health centres + concession: 316 + 54 = 370 (1,39) Total: 267 + 370 = 637 (among them 207 residents)   Working, registred paediatritcans at primary level (estimate)= 230 All paediatricians= 743 (642 active + 101 retired) Total: 0,32 active paediatritian/1.000 inhabitants Total doctors: 2,6/1.000 inhabitants In average 1 paediatrician takes care of approx. 1500 children (ideal 800; max. 4500) Very low mortality: 1,7/1000 live births (OECD average : 3,8/1000 live births); Good pre- and peri-natal care! Source: Health at a Glance 2015; Slovenian National Institute for Public Health for OECD report Slovenian Health Insurance webpage, 2017

Problem areas in primary paediatrics in Slovenia Number of patients (MDs?) Standard of care? How many patients? How old? How to take care? -prevention -systematic screening -diagnostics -treatment -> need for EU? Guidelines / harmonisation of practices

PCP – species near extinction in EU? Members of the Primary– Secondary Working Group (PSWG) of the European Academy of Paediatrics (EAP): Paediatric primary care in Europe: variation between countries. Arch Dis Child 2010;95:791–795. doi:10.1136/adc.2009.178459 http://www.strategic-pediatric-alliance.org/content/page/13/paediatric-primary- care-europe-variation-between-countries:

Which are the main problems of PC Paediatricians in Slovenia? Too few PCP (Average: 40-60 visits/d (8h) including routine screening/sistematics) Administrative solution/problem -IT support user (un)friendly programmes, E-Rp, E-refferals -Electronic (personalized) health record (allows exchange of info among doctors) -Doctor‘s approval of parental leave, each day, due to child sickness: necessary! Financial restrictions for certain diagnostics, which now needs refferal: for now this is a solution, because it spares You time (in long term costs much more!)

Good practice in Slovenia Children with special care needs: specialised PCP Nfth + (speech therapist, psychologist; community: spec. pedagogue, social worker) Chronically ill children can be included (but the majority have developmental issues) Network still needs to be constructed (works partially in some regions) 11 months fully paid maternal leave, state nurseries

Health centres, health booklet, WHO Magna carta of health... Brown TM, Fee E. Andrija Stampar. Charismatic Leader of Social Medicine and International Health. Am J Public Health 2006; 96(8): 1383. doi:  10.2105/AJPH.2006.090084 Family centered care our standard since 1919!

A new/old concept? Patient- and family-centered care is an innovative approach to the planning, delivery, and evaluation of health care that is grounded in a mutually beneficial partnership among patients, families, and providers that recognizes the importance of the family in the patient’s life.   COMMITTEE ON HOSPITAL CARE and INSTITUTE FOR PATIENT- AND FAMILY-CENTERED CARE. From the American Academy of Pediatrics Policy Statement.Patient- and Family-Centered Care and the Pediatrician's Role. Pediatrics 2012, 129 (2): 394-404.

Maybe Europe got it all?! Members of the Primary– Secondary Working Group (PSWG) of the European Academy of Paediatrics (EAP): Paediatric primary care in Europe: variation between countries. http://www.strategic-pediatric-alliance.org/content/page/13/paediatric-primary-care- europe-variation-between-countries: „Heterogeneity of the systems and organisations of PPC in Europe should be regarded as an opportunity to compare and obtain information on their quality. However, more sensitive and specific healthcare indicators, which should be routinely and uniformly collected in all countries, are necessary.“ Should we still be collecting data (yes, however...) or do we have enough information to work it out?

Pros and cons Because community hospitals vary significantly in their resources for providing pediatric care, there is no single set of criteria for admission and transfer of pediatric patients that has universal applicability. Each institution must assess its own capabilities and limitations in light of its mission, and then formulate guidelines. Once guidelines for transfer of patients have been established, those for admission become less difficult to define. This is a challenging process that requires input from all members of the health care team including hospital administration. The goal is to ensure optimum care for each patient in the facility that is most appropriate for the patient's medical and psychosocial needs. Committee on Hospital Care. Facilities and Equipment for the Care of Pediatric Patients in a Community Hospital. Pediatrics 1998, 101(6): 1089-93.

How can ECPCP help to solve your problem? Good practice examples Development of EU standards: 1) STRUCTURE -No. of PCP/inhabitants in EU -No. of children (preschool, school, chronically ill)/PCP -Hospital vs. PC standards + local infrastructure influence 2) CONTENT -Standards of MINIMAL and OPTIMAL, not MAXIMAL care: -for diagnostics and treatment (already done for gastroenteritis) -for prevention -harmonisation of vaccination!!!

How can we increase our visibility and productivity? EU legislation Realistic and helpful standards and norms Good practice Paediatric knowledge exchange; exchange in PEOPLE: practical schools/modules in PCP! PC vs. Hospital care: financial and personal support from NGO, EU grants, community sectors (not a priori health sectors!) Integrative/holistic approach towards CHILDREN‘s HEALTH! (already existing resources of community; social and educational services and governmental and NG agencies)

What can ECPCP do to be the reference for Primary Paediatric Care (PPC) in Europe?

„Investments in adolescent health and wellbeing are some of the best that can be made, resulting in a 10-fold economic benefit, and are vital for the progress towards achieving the UN’s Sustainable Development Goals.“ Lancet April 19, 2017; Building the foundations for sustainable development: a case for global investment in the capabilities of adolescents