APRIL2002

What is primary health care for children and adolescents?

Primary health care generally serves as the first point of contact with the health care system. It is also described as health care that is accessible and affordable, continuous and comprehensive, and coordinated to meet the health needs of the individual and the family being served (Pediatric Primary Health Care, Policy Statement, American Academy of Pediatrics, November 1993).

Who provides primary health care for children and adolescents?

The Bureau of Primary Care and the Bureau of Health Professions in the Federal Department of Health and Human Services define primary care providers to include practitioners in the fields of family medicine/practice, general internal medicine, general pediatrics, and preventive medicine, as well as nurse practitioners and physician assistants. This definition, of course, applies to all age groups. Primary care providers trained in the care of children and adolescents (ages birth to 21 years) include:

• Pediatricians

• Family Practice Physicians

• Pediatric Nurse Practitioners

• Physician Assistants

Physician Assistants must work under the direct and constant supervision of a physician. Depending on individual state laws, Pediatric Nurse Practitioners may practice independently under the general supervision of a physician.

What health services should be provided as primary health care?

Regardless of the type of provider and/or setting, comprehensive primary health care of children and adolescents should encompass the following services:

• Provision of preventive care including, but not restricted to, immunizations, growth and development assessments, appropriate laboratory screening, health care supervision, and child/adolescent and parental counseling about health, psychosocial issues, strengths, needs, risk factors and community resources.

• Assurance of ambulatory and inpatient care for acute illnesses, 24 hours a day, 7 days a week; during the working day, after hours, on weekends, 52 weeks of the year.

• Provision of care over an extended period of time to enhance continuity.

• Identification of the need for subspecialty consultation and referrals and knowing from whom and where these can be obtained. It also includes provision of medical information about the patient to the consultant, evaluation of the consultant's recommendations, implementation of recommendations that are indicated and appropriate, and interpretation of these to the family.

• Interaction with school and community agencies to be certain that special health needs of the individual child are addressed.

• Maintenance of a central record and database containing all pertinent medical information about the child, including information about hospitalizations. This record should be accessible, but confidentiality must be assured. (The Medical Home, Policy Statement Pediatrics, Volume 90, Number 5, American Academy of Pediatrics, November, 1992, page 774)

The scope of these services is the minimum that should be provided. Each child or adolescent and his/her family are unique, and additional services must be provided to fit the needs of the child and/or adolescent.