Strengthening primary care for children

An innovative pilot study helps to strengthen the care of children in the community by integrating paediatricians into five GP clinics across the North-West Melbourne region.

The Australian health care system is an important service delivery platform, although a variety of barriers exist that may prevent children from accessing and receiving the care they need when they need it.

Key takeaways

  • An innovative study trialled a new model of care to help children access quality support in the community and reduce pressure on hospital-based services.
  • The pilot findings are promising as they show the new model of care may help to improve care for children and families in the community.
  • The results suggest that the new model of care is feasible, is seen to be of value to GPs, families and paediatricians and has the potential to reduce the burden on hospital emergency departments and outpatient clinics.

What did the study aim to do?

The new model of care supported GPs and families with weekly ½ day paediatrician-GP co-consultation sessions based at the GP practice, monthly 1-hour case study discussions with paediatricians, GPs, Nurses, and other GP practice staff; and phone and email support for GPs in between.

The study wanted to find out if the new model of care was feasible (i.e. if it worked in a real-world setting) and if it was considered acceptable to families, GPs and paediatricians.

The researchers also wanted to know if the model of care helped GPs to feel more confident in providing paediatric care for common childhood conditions, and if it helped to reduce the number of GP referrals or parent requests for referrals to hospital outpatient and emergency departments.

What did the study find?

Over a 12 month period, 624 children were seen in co-consults with their GP and a paediatrician.

The largest group of children (26%) were referred for a co-consult session (with a GP and paediatrician) for developmental/behavioural concerns.

Other common reasons for referral were asthma and allergies, constipation and bowel problems, other problems (e.g. dizziness, weight concerns, growth delays); and mental health.

Benefits for families

Surveys were completed with 139 families in the GP waiting room after the intervention. Families reported increased confidence in the care provided by their GP, and were less likely to request a referral to a paediatrician.

In-depth interviews with a smaller group of families (n=13) revealed that all of the families would recommend the model of care to other families.

The families reported they found benefits in the ease and comfort of receiving paediatric care at their GP clinic.

They also felt there was a clinical benefit of having the paediatrician and GP consulting in the same room, as information was shared accurately and quickly between clinicians without families having to remember and pass on information over multiple appointments.

Clinical and system benefits

All GPs reported that they felt the model is beneficial for their practice and that it increased their confidence in managing common childhood conditions.

GP quality of care also improved for two example conditions, with GPs prescribing fewer unnecessary medications in children with bronchiolitis and reflux, crying or irritability.

The pilot also saw a reduction in the number of referrals made by GPs to hospital outpatient clinics and Emergency departments.

Where to from here

The research team plan to find out whether the integrated model of care is effective and cost-effective in reducing referrals to hospital services, strengthening GP paediatric care, and increasing family confidence in GP care in a large, two state trial.

For more information, contact Professor Harriet Hiscock.

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