Lapse tervise jälgimise juhend (ajakohastatud) / Child health monitoring guide (updated)

ABSTRACT

In a small country, every person and their potential contribution to society is extremely important. The degree to which the welfare of children and families is invested will sooner or later be reflected in the health of the population, education, crime, employment and the economy. Healthy children can grow into healthy and full members of society. There are approximately a quarter of a million children under the age of 18 in Estonia. The topics covered in the Children's Health Monitoring Guide are extensive. The health check-up guide for children up to 18 years of age, which has been in force until now, was drawn up in 2009. Since a large part of the old guide is still suitable for use, the working group decided to supplement it with up-to-date evidence-based information that would help to make the necessary decisions and implement appropriate interventions when working with children and families. The main task of the primary level is to support the health and well-being of children, young people and families, i.e. the human capital of the Estonian state, and to prevent diseases. As a result of the establishment of primary health centers, it is possible to offer more versatile health services. These services should be equally available to all children in Estonia, regardless of place of residence, social background or financial means of the parents. The goal is to monitor the health of all children in Estonia based on the same rules centrally, consistently, at the regional health center and at school for the child and his family. In order to organize work more efficiently, the division of labor of healthcare workers has been revised. In order to improve the child's health promotion, disease prevention and treatment management, it is necessary to expand and improve the exchange of information between the fields of family medicine, midwifery, school health, specialist medical care, study counseling and child protection. If children's development is monitored and health risks are assessed and screened by a primary health care worker, there is more time for specialist medical care to more effectively treat and monitor children with more serious health problems. A welfare society brings more and more problems with the abundance of opportunities. Therefore, the guide pays attention to the assessment of children's health risks and their screening based on both mental and somatic developmental disorders as well as the socially difficult growing environment. Early detection, diagnosis, timely intervention and treatment of risks can improve the quality of life of children and families and reduce healthcare costs. The update of the guide was initiated by the Department of Children and Families of the Ministry of Social Affairs in cooperation with the Department of Health System Development, whose priorities are prevention, early detection and the organization of appropriate and timely assistance. The update of the manual was started with the support of the Norwegian Financial Mechanism within the project "Integrated service concept for supporting children's mental health". Updating recommendations for child eye examination and visual acuity assessment Guidelines for a child's eye examination and visual acuity assessment differ from country to country. In particular, the eye examination of children differs in what age it is performed, what tests are used, and where and which specialist examines the child. In other parts of the world, a large part of the guidelines regarding a child's eye examination are based on expert opinions. In 2021, the Estonian Society of Family Physicians and the Estonian Society of Ophthalmologists agreed on the e-consultation referral and response requirements when referring a child up to the age of 15 to an ophthalmologist's e-consultation / ophthalmologist. As the options for seeing an ophthalmologist changed, there was a need to update the recommendations regarding eye examination and visual acuity in the "Child Health Monitoring Guide". The treatment manual gives recommendations on at what age the child should have an eye examination and visual acuity assessed, and which eye examination activities are important based on age. The updated information provides an opportunity to evaluate the child's eye examination practice on the same basis throughout the country, to analyze it, to correct and manage it if necessary. The implementation of the treatment manual helps to harmonize the competence of the target group of the treatment manual when performing a child's eye examination. The expected benefit and goal of the recommendations of the treatment guide is the earlier detection of childhood eye pathology and visual acuity decline.

Väikeses riigis on iga inimene ja tema võimalik panus ühiskonda erakordselt oluline. See, mil määral panustatakse laste ja perede heaolusse, kajastub varem või hiljem rahvastiku tervises, hariduses, kuritegevuses, tööhõives ja majanduses. Tervetest lastest saavad kasvada omakorda ühiskonna terved ja täisväärtuslikud liikmed. Eestis on ligikaudu veerand miljonit kuni 18-aastast last. Laste tervise jälgimise juhendis käsitletud teemad on ulatuslikud. Seni kehtinud kuni 18-aastaste laste tervisekontrolli juhend on koostatud 2009. aastal. Kuna suur osa vanast juhendist sobib endiselt kasutamiseks, otsustas töörühm seda täiendada ajakohase tõenduspõhise infoga, mis aitaks töös laste ja peredega teha vajalikke otsuseid ja rakendada sobivaid sekkumisi. Esmatasandi põhiülesanne on toetada laste, noorte ja perede ehk Eesti riigi inimvara tervist ja heaolu ning ennetada haigusi. Esmatasandi tervisekeskuste rajamise tulemusel on võimalik pakkuda mitmekülgsemaid tervishoiuteenuseid. Need teenused peaksid olema kõikidele Eesti lastele ühetaoliselt kättesaadavad, sõltumata elukohast, sotsiaalsest taustast või vanemate varalistest võimalustest. Eesmärk on kõikide Eesti laste tervist jälgida ühetaoliste reeglite alusel lapse ja tema pere keskselt, järjepidevalt, piirkondlikus tervisekeskuses ja koolis. Töö tõhusamaks korralduseks on üle vaadatud tervishoiutöötajate tööjaotus. Lapse tervisedenduse, haiguste ennetamise ja ravikorralduse parandamiseks on vaja laiendada ja tõhustada infovahetust perearstiabi, ämmaemandusabi, koolitervishoiu, eriarstiabi, õppenõustamise ja lastekaitse valdkondade vahel. Kui laste arengut jälgib ning terviseriske hindab ja sõelub esmatasandi tervishoiutöötaja, jääb eriarstiabis enam aega tõhusamalt ravida ja jälgida raskemate terviseprobleemidega lapsi. Heaoluühiskond toob võimaluste külluses üha sagemini ka probleeme. Seetõttu on juhendis pööratud tähelepanu laste terviseriskide hindamisele ja nende sõelumisele, lähtudes nii psüühilistest ja somaatilistest arenguhäiretest kui ka sotsiaalselt raskest kasvukeskkonnast. Riskide varasema märkamise, diagnoosimise, õigeaegse sekkumise ja raviga on võimalik parandada laste ja perede elukvaliteeti ning vähendada tervishoiukulutusi. Juhendi uuendamise algatas Sotsiaalministeeriumi laste ja perede osakond koostöös tervisesüsteemi arendamise osakonnaga, kelle prioriteedid on ennetustegevus, varajane märkamine ning asjakohase ja õigeaegse abi korraldamine. Juhendi uuendamist alustati Norra finantsmehhanismi toetusel projekti "Integreeritud teenuste kontseptsioon laste vaimse tervise toetamiseks" raames. Lapse silmakontrolli ja nägemisteravuse hindamise soovituste ajakohastamine Lapse silmakontrolli ja nägemisteravuse hindamise juhendid erinevad riigiti. Eelkõige erineb laste silmakontroll selle poolest, millises vanuses seda tehakse, milliseid teste kasutatakse ning kus ja milline spetsialist lapse läbi vaatab. Mujal maailmas on suur osa lapse silmakontrolli puudutavatest juhistest antud eksperdiarvamuste põhjal. 2021. aastal leppisid Eesti Perearstide Selts ja Eesti Oftalmoloogide Selts kokku e-konsultatsiooni saatekirja ja vastuse nõuetes kuni 15-aastase lapse suunamisel silmaarsti e-konsultatsioonile / silmaarstile. Kuna võimalused silmaarsti vastuvõtule saatmiseks muutusid, tekkis vajadus ajakohastada "Lapse tervise jälgimise juhendi" silmakontrolli ja nägemisteravust puudutavaid soovitusi. Ravijuhendiga antakse soovitused selle kohta, millises vanuses tuleb lapsele silmakontrolli teha ja nägemisteravust hinnata ning millised silmakontrolli tegevused on vanusepõhiselt olulised. Ajakohastatud info annab võimaluse hinnata lapse silmakontrolli praktikat samadel alustel kogu riigis, seda analüüsida, vajaduse korral korrigeerida ja juhtida. Ravijuhendi rakendamine aitab ühtlustada ravijuhendi sihtrühma pädevust lapse silmakontrolli tegemisel. Ravijuhendi soovituste oodatav kasu ja eesmärk on lapseea silmapatoloogia ja nägemisteravuse languse varasem avastamine.