Diversity of kidney care referral pathways in national child health systems of 48 European countries
Authors: Tasic Velibor , Edvardsson Vidar O. , Preka Evgenia , Prikhodina Larisa , Stefanidis Constantinos J. , Topaloglu Rezan , Shtiza Diamant , Sarkissian Ashot , Mueller-Sacherer Thomas , Fataliyeva Rena , Kazyra Ina , Levtchenko Elena , Pokrajac Danka , Roussinov Dimitar , Milošević Danko , Elia Avraam , Seeman Tomas , Faerch Mia , Vainumae Inga , Kataja Janne , Tsimaratos Michel , Rtskhiladze Irakli , Hoyer Peter F. , Reusz George , Awan Atif , Lotan Danny , Peruzzi Licia , Nigmatullina Nazim , Beishebaeva Nasira , Jeruma Edite , Jankauskiene Augustina , Niel Olivier , Said-Conti Valerie , Ciuntu Angela , Pavićević Snežana , Oosterveld Michiel , Bjerre Anna , Tkaczyk Marcin , Teixeira Ana , Lungu Adrian C. , Tsygin Alexey , Stojanović Vesna , Podracka Ludmila , Kersnik Levart Tanja , Espino-Hernández Mar , Brandström Per , Sparta Giuseppina , Alpay Harika , Ivanov Dmytro , Dudley Jan , Khamzaev Komiljon , Haffner Dieter , Ehrich Jochen 
Published: January 2024

Background

Primary, secondary and tertiary healthcare services in Europe create complex networks covering pediatric subspecialties, sociology, economics and politics. Two surveys of the European Society for Paediatric Nephrology (ESPN) in 1998 and 2017 revealed substantial disparities of kidney care among European countries. The purpose of the third ESPN survey is to further identify national differences in the conceptualization and organization of European pediatric kidney health care pathways during and outside normal working hours.

Methods

In 2020, a questionnaire was sent to one leading pediatric nephrologist from 48 of 53 European countries as defined by the World Health Organization. In order to exemplify care pathways in pediatric primary care nephrology, urinary tract infection (UTI) was chosen. Steroid sensitive nephrotic syndrome (SSNS) was chosen for pediatric rare disease nephrology and acute kidney injury (AKI) was analyzed for pediatric emergency nephrology.

Results

The care pathways for European children and young people with urinary tract infections were variable and differed during standard working hours and also during night-time and weekends. During daytime, UTI care pathways included six different types of care givers. There was a shift from primary care services outside standard working hours to general outpatient polyclinic and hospital services. Children with SNSS were followed up by pediatric nephrologists in hospitals in 69% of countries. Patients presenting with community acquired AKI were admitted during regular working hours to secondary or tertiary care hospitals. During nights and weekends, an immediate shift to University Children's Hospitals was observed where treatment was started by intensive care pediatricians and pediatric nephrologists.

Conclusion

Gaps and fragmentation of pediatric health services may lead to the risk of delayed or inadequate referral of European children with kidney disease to pediatric nephrologists. The diversity of patient pathways outside of normal working hours was identified as one of the major weaknesses in the service chain.