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Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

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 G
+ Author Affiliations
- Author Affiliations

A 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.


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