The number of emergency visits (i.e. visits on the same day as the first contact for the problem in question was taken) by a defined population of pre-school children in Stockholm was studied during three months in 1977 and 1982. The aim was to describe the pattern of utilization of care. In 1982 we wanted to study whether instructions to integrate preventive and curative care at Child Health Centres (CHCs) had altered this pattern. All visits to nurses and physicians providing emergency care for children were recorded. The total number of visits was 33 per 1 000 children per week in 1977, and 39 (age-adjusted) in 1982. The increase was attributed to visits to the Child Health Centres. Thirteen and 28% of all the visits, respectively, were paid to the CHC nurses. Considering visits to a physician, there was only a slight increase from 1977 to 1982. In 1977 20% of the visits to a physician occurred within the primary health care organization. In 1982 the figure was 41%. A 29% decrease was recorded for the emergency services at the hospitals, from 1977 to 1982. Our findings show that the nurses at the Child Health Centres are a very important but little recognized resource for the care of sick children. At the CHCs the services are usually established in a way that follows the principles agreed on for the primary health care. It would seem suitable to use these resources also for curative care.
Swedish speaking parents of 446 children, all around one year of age and living in the suburbs of Stockholm, participated in a three-week diary study. The aim was to describe the pattern of illnesses in children and the measures taken in the family and to correlate the findings with the socio-economic conditions of the family. A health complaint, most frequently running or blocked nose or a cough, was recorded for about 1/3 of the days of observation. Some form of family action was recorded on 70% of these days. Medicines were given on 39% of the complaint days and relatives, friends or a health professional were contacted on less than 10% of the days. In case of acute respiratory infection medicines were given or a health professional contacted more often if the symptom was recorded as severe. Most frequently the Child Health Centre nurse was consulted. The measures taken by the parents were judged to be rational. However, one quarter of the parents expressed uncertainty about the care of the acute infectious disorders of the child. Correlations between family response and socioeconomic factors were weak.
The aim of the study was to describe the working patterns of nurses at Child Health Centres in Stockholm and the changes in those patterns over a 5-year period. Time-motion studies and interviews were used. According to the results about 50% of working time was spent in a direct contact with families. The distribution of the working time on different tasks was roughly the same in two surveys carried out in 1977 and 1982. Additional duties assigned to the nurses were managed thanks to a decrease in the number of children in the districts. The time-motion method gave reliable information on the nursing work pattern and how this was influenced by new procedures that were implemented.
Results from a few studies on community paediatrics in suburbs of Stockholm are presented. Pattern of diagnoses, utilization of care and social and psychological team work are discussed. Goals of the paediatric service in the primary care are set up and a distribution of duties between different professionals is suggested.