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“The Future of Ambulatory Pediatrics - Networking”
Dr. ARIEH BAHIR
Pediatrician, Allergy & Clinical Immunology Specialist
Strasbourg, June 23, 2012
<<Pediatrics, yesterday, today, tomorrow, here and elsewhere>>
3rd annual meeting of ECPCP
AFPA 20ème Congrès National
Arieh BAHIR, M.D Pediatrician, Allergy & Clinical Immunology Specialist
1993-Present Medical Director The Pediatric Ambulatory Center, Bat Yam, Israel Senior Physician The Allergy and Clinical Immunology unit Sapir Medical Center, Meir General Hospital, Kfar Saba, Israel EDUCATION
1977-1980 Medical School The Technion - Israel Institute of Technology, Haifa, Israel 1982-1985 Residency Kaplan Medical Center, Rehovot, Israel Affiliated to the Medical School of The Hebrew University and Hadassah, Jerusalem Board Certified in Pediatrics (Israel) 1990-1992 Fellowship The Allergy and Clinical Immunology Unit Sapir Medical Center, Meir General Hospital, Kfar Saba, Israel Board Certified in Allergy & Clinical Immunology (Israel)
Clalit Health Services
2nd Largest non government health services in the world
54% Market Share in Israel (>4 M members)
~2,000 community clinics including Child Healthcare centers, Women
Healthcare centers and large Consultant Medicine clinics
14 hospitals - General, Children, Psychiatric, Rehabilitation & Geriatric
33 Pediatric Healthcare Centers
27 of them are recognized for residency
Aims, Goals & Advantages
• Pediatric services and follow-up in the
community from infancy to adolescence
• Immediate treatment for children with a variety
of acute illnesses including emergency
problems
• Specializing in ambulatory pediatrics including
the new “hidden” morbidity
• Detection and monitoring of diseases and
disorders at an early stage
Pediatric Healthcare Center, Bat Yam
Availability & Accessibility
• The Center is open 6 days a week
• Working hours 07:30-19:00
• Central location
• Free parking
• Close to major bus-line stops
• Convenient access for wheelchairs and prams
Pediatric Healthcare Center, Bat Yam
Pediatric Healthcare Community Center, Bat Yam
• The largest, well equipped and most modern
children's clinic in its region
• Provides immediate diagnosis and treatment,
as well as primary children's medical services and
follow-up, to 5,600 infants, children and
adolescents
• A comfortable waiting room for children and
parents for follow-up and treatment (IV Fluids,
inhalation therapy and follow-up after head
trauma)
Staff Primary Pediatric Care
Pediatric Healthcare Center, Bat Yam
Secondary Pediatric Care
• 4 Board Certified Pediatricians
• 3 Secretaries - local workers,
familiar with local habits
• 4 Nurses - Well experienced in the
care of infants, children and youth
• Nutritionist - Well experienced in
working with children and parents
• Social Worker
• Orthopedics
• Asthma and Allergies
• Endocrinology
• Psycho-social Consulting
• Pediatric Surgeon
• Adolescent medicine
Primary care
The center is operated by expert pediatricians
with years of experience in community pediatric
work.
Expert pediatricians’ presence at all times
enables immediate diagnosis and treatment.
Example:
5 months old, 40*c for 24h, no physical signs.
Will be examined twice a day in the next 48 h
CBC, Urine general test, Urine culture
Follow-up on patients from birth to adolescence.
Nurses with experience in the care of infants,
children and youth
Pediatric Healthcare Center, Bat Yam
Professional Nurse Services
Highly skilled professional nurses provide:
• Primary treatment also using medical equipment -
spirometer, oxidization measurement device etc.
• Monitoring parameters - Asthma, iron
administration, Hgb levels, BMI measurements
• Routine nursing services
• Preventive medicine guidance
• Breastfeeding promotion and guidance
• Lectures to the public on various health topics
Pediatric Healthcare Center, Bat Yam
The "Shiluv Clinic" (liaison clinic)
• To recognize and identify psycho-behavioral difficulties and disorders in children
• Identifying and locating psycho-behavioral problems and directing children and
parents to appropriate treatment
• The staff includes a child psychiatrist and a child psychologist from the
local psychiatric hospital, working in conjunction with the clinic
The most common problems identified at the clinic:
• Attention Deficit Hyperactivity Disorders
• Family interaction disorders - including parent-child problems
Pediatric Healthcare Center, Bat Yam
Adolescent Clinic
Managed by a trained expert pediatrician.
Deals with various issues that youngsters and their parents are concerned about,
ranging from the normal physical changes of puberty to eating disorders or behavioral
problems
Most common reasons for turning to the clinic :
• Obesity
• Problems related to the menstrual cycle
• School problems
Pediatric Healthcare Center, Bat Yam
• Instructing sixth year medical students as part of their studies and training
“…Dean’s office has decided to incorporate community experience in the clinical academic program
in the School of Medicine… students must be exposed to the unique clinical activity taking place in the community”.
Prof. Y. Makori, Dean, Sackler Faculty of Medicine, Tel Aviv University
• Academically recognized by the Scientific Council of the Israeli Medical
Association and by the Ministry of Health
• Weekly academic staff meetings
• Periodic academic meetings of pediatricians with the clinic staff
• Participation in multi-national study on the effectiveness and safety of a
seasonal flu vaccine (Flumist), published in the NEJM medical journal in 2004
Academia
Pediatric Healthcare Center, Bat Yam
Quality Parameters in Pediatric Primary Care
• Hemoglobin test, 9-18 months*
• Rate of Anemia, 9-18 months
• BMI measurement children, 5-7 years*
• BMI measurement adolescent, 13-17 years
• Documentation of obese children and adolescents
with BMI percentile >95%
• Proper treatment of children and adolescents with Asthma, 5-17 years*
• Flu vaccination of healthy infants, 6-23 months
• Flu vaccination of children and adolescent with chronic diseases
* National Indicators
Pediatric Healthcare Center, Bat Yam
The Role of Medical Quality Parameter in Preventive Medicine
Characterization of patients on the prevalence of Anemia in childhood
Anemia Prevalence in Lower Socioeconomic Status Population %
25.6% Decrease
28.6% Decrease
Q1/2005 Q4/2009
Q1/2005 Q4/2009
Rate of Anemia, 9-18 months
Pediatric Healthcare Center, Bat Yam
Quality Parameters Participants
• Pediatricians
• Nurses
• Computers and Information Consultants
• Database Manager
• Administration Representative
Pediatric Healthcare Center, Bat Yam
Summary
Pediatric Healthcare Center, Bat Yam
The model we propose may prove itself, as already
shown in our case, as a proper answer to the challenges
which modern community pediatrics, the academia and
preventive medicine will face in the future
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