Standardisation of care: towards a common goal

In addition to training, the management of specific conditions is also being standardised throughout Europe and across the world. The need for standardisation of management was illustrated by a paper published in 1998, which compared the management of a common respiratory infection in infancy (bronchiolitis) in many European countries and in the USA. The main factor linked to the length of stay in hospital was not severity of illness but the country in which the infant lived. A 2010 study of cystic fibrosis across Europe identified fewer individuals surviving to adulthood in non-EU compared with EU countries, and suggested that up to 50% of all cases of cystic fibrosis in non-EU countries were not being diagnosed (and by implication, not receiving appropriate treatment). The considerable variation between countries, and the desire to standardise PRM training, has driven the standardisation of treatment and investigation. Table 3 lists some of the areas in which guidelines have been established.

The investigation and management of several conditions has now been standardised. However, it is important to note that for most conditions, no internationally agreed guideline exists, and many of the guidelines that do exist are based on consensus (i.e. what is currently being done) and rarely on an evidence base (i.e. clinical trials). To take drug dose as an example, most antibiotic doses are based on studies performed in adults with the assumption that children are small adults; however, this is often not the case and generally children receive inadequate doses of medication. There is a pressing need for clinical trials in PRM and this has been recognised by the 2006 EU Clinical Trials Directive, which obliges the pharmaceutical industry to test new medications in children as well as adults.

Mandatory  
  Respiratory symptoms and signs
Pulmonary function testing
Airway endoscopy
Imaging
Acute and chronic lung infection
Tuberculosis
Cystic fibrosis
Bronchial asthma
Allergic disorders
Congenital malformations
Bronchopulmonary dysplasia
Rare diseases
Sleep medicine
Rehabilitation
Inhalation therapy
Technology-dependent children
Epidemiology and environmental health
Management and leadership
Teaching
Communication
Research
Optional  
  Rigid and interventional endoscopy
Post lung transplant management
Additional diagnostic tests
Table 2 - Modules of the Paediatric HERMES syllabus. HERMES: Harmonised Education in Respiratory Medicine for European Specialists.

See the entire Paediatric respiratory medicine Chapter