title: Treatment of children with cystic fibrosis: central, local or both?
abstract: Owing to a lack of longitudinal studies, the effect of centralization of care on pulmonary function and survival remains unclear. Three different levels of involvement of centralized care in the treatment of paediatric cystic fibrosis patients were compared with regard to longitudinal pulmonary function and nutritional and microbiological status in a 3-y period, and the literature was reviewed on the possible advantages and disadvantages of centralized care. The study included 105 paediatric patients attending the Cystic Fibrosis Centre between January 1997 and January 2001. Twenty-three patients were treated by local paediatricians according to the protocol of the Centre and were seen only once a year at the Centre, for an annual check-up (local care). Forty-one patients were treated at the Centre only (centralized care). The remaining 41 patients were treated in close cooperation between the Centre and local hospitals, with patients visiting the doctors alternately (shared care). The mean annual changes in pulmonary function and body mass index from all patients, as well as a microbiological survey, were reviewed. No significant differences were found between the three groups for annual changes in FEV1, FVC and body mass index, nor did the review of microbial colonization show any significant differences between the groups. Because the groups in this study were relatively small, the results might have been influenced by lack of power.
  
  
  CONCLUSIONS
  In this relatively small group, no differences in pulmonary function, nutritional status or microbiological colonization between the three levels of involvement of centralized care could be found. This could signify that local paediatricians have a special role in the care for patients with cystic fibrosis, in close cooperation with the specialists at the Centre.
authors.affiliation: University Medical Centre Utrecht, Department of Paediatric Pulmonology, The Netherlands.
authors.forename: L M E
authors.initials: LM
authors.lastname: van Koolwijk
authors.forename: C S P M
authors.initials: CS
authors.lastname: Uiterwaal
authors.forename: J
authors.initials: J
authors.lastname: van der Laag
authors.forename: J H
authors.initials: JH
authors.lastname: Hoekstra
authors.forename: V A M
authors.initials: VA
authors.lastname: Gulmans
authors.forename: C K
authors.initials: CK
authors.lastname: van der Ent
mesh_terms: D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000592:standards* / Q000639:trends; D003550:Cystic Fibrosis / Q000175:diagnosis* / Q000628:therapy*; D003695:Delivery of Health Care / Q000379:methods; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands; D009752:Nutritional Status; D018802:Patient-Centered Care / Q000592:standards* / Q000639:trends; D010372:Pediatrics / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome