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.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.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.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.
