Meeting the needs of children and families in chronic illness and disease. A greater role for the GP?

BACKGROUND: Care of children with chronic disease is an important part of general practice. While the emphasis of management has traditionally been on the biomedical aspects of ill health categorised by specific medical diagnoses, other dimensions may be important.
OBJECTIVE: To define chronic disease and illness. To describe 'non categorical' dimensions or common features of different chronic diseases in childhood and their impact on the child and family involved. To explore needs for care and the role of the general practitioner in providing this care.
METHOD: A literature review based on a search of the Medline electronic database. Both quantitative and qualitative articles on the topic of non-categorical or generic approaches to chronic childhood disease were selected on the basis of their quality and relevance to the Australian health care system.
RESULTS: Chronic illness disturbs the lives of children, limiting their roles in schools, recreation, and vocational pursuit. Parents and siblings often experience social, economic and personal disadvantage. Care that is orientated to the 'whole child' and facilitates 'family control' in the various stages of illness and disease promotes better coping. Non-categorical management is optimised by continuity of both the setting and provider, with a provider who co-ordinates care. DISCUSSION: Chronic illness management offers a challenge to general practitioners to take on an expanded generalist role. This should complement specialised activities. When technical or specialised disease orientated care bypasses the general practitioner, important elements may be neglected. Proposed case management reforms are a stimulus to reappraise the role of general practitioners in chronic illness and disease care.