Pediatrician, Allergy & Clinical Immunology Specialist · Arieh BAHIR, M.D Pediatrician, Allergy & Clinical Immunology Specialist 1993-Present Medical Director The Pediatric Ambulatory

“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 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


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


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


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


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


• 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


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


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


Quality Parameters Participants

• Pediatricians

• Nurses

• Computers and Information Consultants

• Database Manager

• Administration Representative


Summary


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

Thank You

for Your Attention

[email protected]

mailto:[email protected]

Documents

Pediatrician, Allergy & Clinical Immunology Specialist · Arieh BAHIR, M.D Pediatrician, Allergy & Clinical Immunology Specialist 1993-Present Medical Director The Pediatric Ambulatory