Strengthening care for children: pilot of an integrated general practitioner–paediatrician model of primary care in Victoria, Australia
Harriet Hiscock A B C H , Rachel O’Loughlin A B , Rachel Pelly B , Catherine Laird A , Jessica Holman D , Kim Dalziel B E , Shaoke Lei A B , Douglas Boyle F and Gary Freed GA Health Services Research Unit, The Royal Children’s Hospital, 50 Flemington Road, Parkville, Vic. 3052, Australia. Email: rachel.oloughlin@mcri.edu.au; cath.laird@rch.org.au; shaoke.lei@mcri.edu.au
B Health Services, Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, Vic. 3052, Australia. Email: rachel.pelly@mcri.edu.au; kim.dalziel@unimelb.edu.au
C Department of Paediatrics, The University of Melbourne, Vic. 3010, Australia.
D North Western Melbourne Primary Health Network, 369 Royal Parade, Parkville, Vic. 3052, Australia. Email: jessica.holman@nwmphn.org.au
E Centre for Health Policy, The University of Melbourne, Vic. 3010, Australia.
F Department of General Practice, The University of Melbourne, Vic. 3010, Australia. Email: dboyle@unimelb.edu.au
G Department of Pediatrics, University of Michigan, 500 S. State Street, Ann Arbor, MI 48109, USA. Email: gfreed@med.umich.edu
H Corresponding author. Email: harriet.hiscock@rch.org.au
Australian Health Review 44(4) 569-575 https://doi.org/10.1071/AH19177
Submitted: 9 August 2019 Accepted: 18 November 2019 Published: 12 February 2020
Abstract
Objective The aim of this study was to assess the acceptability of a novel, integrated general practitioner (GP)–paediatrician model of care, aiming to reduce referrals to hospitals and improve primary care quality.
Methods A pre-post study was conducted with five general practice clinics in north-west Melbourne. Over 12 months, 49 GPs and 896 families participated in the intervention that included weekly to fortnightly paediatrician–GP co-consultation sessions at the general practice, monthly case discussions and telephone or email clinical support for GPs. GPs and families completed surveys or interviews at three time points (before the intervention, after running the model for 4 months and at the end of the implementation). Non-identifiable consultation data were extracted from general practice medical records.
Results All GPs found the model acceptable. Although not significant, there was a trend towards a lower proportion of referrals to private paediatricians after the intervention (from 34% to 20%) and emergency departments (from 19% to 12%). Outpatient clinic referrals remained steady, and then increased as the paediatrician left the clinics (31% vs 47% before and after the intervention respectively). Unnecessary prescribing of acid suppression medications decreased by 20% (from 29% to 9%). GPs reported improved confidence in paediatric care (88% vs 100% before and after the intervention respectively). Families reported increased confidence in GP care (78% vs 94% before and after the intervention respectively). Model cost estimates were A$172 above usual care per child seen in the co-consultations.
Conclusions This novel model of care is acceptable to GPs and families and may improve access and quality of paediatric care.
What is known about the topic? A GP–paediatrician integrated model of care appears effective in reducing hospital burden in England, but has not been implemented in Australia.
What does this paper add? This pilot, an Australian first, found that a GP–paediatrician integrated model of care is feasible and acceptable in Australia’s primary healthcare system, improves GP confidence and quality of paediatric care, may reduce paediatric referrals to outpatient clinics and emergency departments and improves family confidence in, and preference for, GP care.
What are the implications for practitioners? This model may reduce hospital burden and improve quality in GP paediatric care while potentially producing cost savings for families and the healthcare system.
Additional keywords: clinical services, consumers, health services research, models of care, primary health care.
References
[1] Australian Bureau of Statistics. 3101.0 – Australian demographic statistics, Dec 2018. 2019. Available at: https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Dec%202018?OpenDocument [verified 25 July 2019].[2] Freed GL, Spike NA, Sewell JR, Moran LM, Britt H, Valenti L, Brooks P. Changes in longer consultations for children in general practice. J Paediatr Child Health 2013; 49 325–9.
| Changes in longer consultations for children in general practice.Crossref | GoogleScholarGoogle Scholar | 23517187PubMed |
[3] Freed GL, Gafforini S, Carson N. The age distribution of emergency department presentations in Victoria. Emerg Med Australas 2015; 27 102–7.
| The age distribution of emergency department presentations in Victoria.Crossref | GoogleScholarGoogle Scholar | 25690308PubMed |
[4] Freed G, Gafforini S, Carson N. Age-related variation in primary care type presentations to emergency departments. Aust Fam Physician 2015; 44 584–8.
| 26510148PubMed |
[5] Braithwaite J, Hibbert PD, Jaffe A, White L, Cowell CT, Harris MF, Runciman WB, Hallahan AR, Wheaton G, Williams HM, Murphy E, Molloy CJ, Wiles LK, Ramanathan S, Arnolda G, Ting HP, Hooper TD, Szabo N, Wakefield JG, Hughes CF, Schmiede A, Dalton C, Dalton S, Holt J, Donaldson L, Kelley E, Lilford R, Lachman P, Muething S. Quality of health care for children in Australia, 2012–2013. JAMA 2018; 319 1113–24.
| Quality of health care for children in Australia, 2012–2013.Crossref | GoogleScholarGoogle Scholar | 29558552PubMed |
[6] Woolfenden S, Short K, Blackmore R, Pennock R, Moore M. How do primary health-care practitioners identify and manage communication impairments in preschool children? Aust J Prim Health 2015; 21 176–81.
| How do primary health-care practitioners identify and manage communication impairments in preschool children?Crossref | GoogleScholarGoogle Scholar | 26509204PubMed |
[7] Freed GL, Turbitt E, Kunin M, Gafforini S, Sanci L, Spike N. General practitioner perspectives on referrals to paediatric public specialty clinics. Aust Fam Physician 2016; 45 747–53.
| 27695726PubMed |
[8] Freed GL, Turbitt E, Kunin M, Gafforini S, Sanci L, Spike N. Children referred for specialty care: parental perspectives and preferences on referral, follow-up and primary care. J Paediatr Child Health 2017; 53 18–25.
| Children referred for specialty care: parental perspectives and preferences on referral, follow-up and primary care.Crossref | GoogleScholarGoogle Scholar | 27696573PubMed |
[9] Gruen RL, Weeramanthri TS, Knight SE, Bailie RS. Specialist outreach clinics in primary care and rural hospital settings. Cochrane Database Syst Rev 2004; 1 CD003798
[10] Montgomery-Taylor S, Watson M, Klaber R. Child health general practice hubs: a service evaluation. Arch Dis Child 2016; 101 333–7.
| Child health general practice hubs: a service evaluation.Crossref | GoogleScholarGoogle Scholar | 26699536PubMed |
[11] Liaw ST, Boyle DIR. Secure data linkage and information sharing with GRHANITE. In: Graham H, editor. Proceedings of HIC 2008 Australia’s Health Informatics Conference; The Person in the Centre; 31 August–2 September 2008; Melbourne, Vic., Australia. Available at: https://www.researchgate.net/publication/237387533_Secure_data_linkage_and_information_sharing_with_GRHANITE [verified 9 August 2019].
[12] Hiscock H, Dalton S, Soon J. The RACP evolve general paediatrics list. J Paediatr Child Health 2017; 53 927–8.
| The RACP evolve general paediatrics list.Crossref | GoogleScholarGoogle Scholar | 28868777PubMed |
[13] Gill SD, Mansfield S, McLeod M, von Treuer K, Dunn M, Quirk F. HealthPathways improving access to care. Aust Health Rev 2019; 43 207–16.
| HealthPathways improving access to care.Crossref | GoogleScholarGoogle Scholar | 29415799PubMed |
[14] Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. 3rd edn. Oxford: Oxford University Press; 2005.
[15] Zurynski Y, Phu A, Deverell M, Elliott E. Paediatric services capacity: an Evidence Check rapid review brokered by the Sax Institute for the NSW Kids and Families. Sydney: Sax Institute; 2015. Available at: https://www.saxinstitute.org.au/wp-content/uploads/Paediatric-services-capacity.pdf [verified 24 January 2020].
