Pediatricians' roles in the provision of developmental services: an international study.

OBJECTIVE To understand how early childhood developmental services are provided in other countries in comparison with the United States. BACKGROUND Recent surveys document gaps in developmental services provided in the United States. Understanding pediatrician roles in other industrialized countries may shed light on how to meet emerging professional expectations around health promotion care and developmental services. DESIGN : Using a typology of preventive and health promotion care, we conducted structured interviews and case vignettes to examine the roles of health professionals in (1) developmental assessment, (2) anticipatory guidance/health promotion, (3) problem-focused counseling, and (4) coordination of service needs. Participants included 20 child health experts and key informants in 10 countries. Roles and systems of providers of care were categorized into several organizational approaches based on these results. RESULTS Pediatricians provide the continuum of primary care developmental services in only a few countries. In contrast to the United States, most of the studied countries have complementary roles for pediatricians and other nonphysician clinicians in preventive care. In many countries, nurses or general practice physicians provide most basic preventive care whereas pediatricians provide more specialized care for developmental/behavioral problems and chronic medical conditions. CONCLUSIONS Recent studies that have documented the poor quality of early childhood health care are pressuring the US pediatric profession to meet increasing expectations in developmental services. Although US pediatricians struggle to incorporate recommendations into their daily practice, most other countries place responsibility for some preventive developmental services with community-based nurses or general practice physicians.