Expanded program linking GPs with paediatricians could keep thousands of children out of hospital  

A program that aims to reduce the number of paediatric emergency department referrals and outpatient clinic visits by linking General Practitioners (GPs) with paediatricians could keep thousands of children out of hospital following a wider roll-out.

The Strengthening Care for Children (SC4C) program was designed by Murdoch Children’s Research Institute clinicians in collaboration with The Royal Children’s Hospital (RCH) and North Western Melbourne Primary Health Network and was initially trialled in five Victorian GP clinics.

Researchers found that integrating paediatricians into GP consultations improved children’s care and kept more children out of hospital. It also significantly boosted the confidence of GPs to treat their young patients and increased parents’ confidence in their local doctors.

After the successful pilot study, the program is now being rolled out in 22 GP clinics in Victoria and New South Wales, through North Western Melbourne Primary Health Network and Central and Eastern Sydney Primary Health Network, to test it in a larger population.

SC4C will use protocols published in BMJ Open which were developed by a national collaboration of child health experts.

The model involves GPs receiving regular visits from paediatricians (weekly for six months and then fortnightly for another six months), monthly case discussions, and telephone and email support provided in between visits. This allows GPs and families to benefit from paediatricians’ specialised experience and refine treatments in line with lessons learned in hospitals.

Based on the pilot study, researchers predict at least a 4 per cent drop in GP paediatric referrals to emergency departments and hospital outpatient clinics. If SC4C were rolled out across Australia, this would equate to tens of thousands fewer children entering hospital every year.

Murdoch Children’s Professor Harriet Hiscock said, “In the last 20 years, Australia’s population of children under 18 has grown rapidly, yet young patients represent a decreasing proportion of GP appointments. Despite this, they make up the largest share of low urgency emergency department presentations, easily outnumbering adults of all ages.”

Research in Australia and the UK revealed that many GPs felt they were inadequately trained for dealing with childhood conditions, while others sometimes noted patchy communication between hospitals and primary care providers concerning children after discharge from emergency departments or wards.

Issues of concern covered chronic conditions such as asthma and acute illnesses such as tonsilitis, as well as mental health and physical injury.

“Australia’s current health care services for children are neither sustainable nor equitable,” Murdoch Children’s Sonia Khano said. “If effective and widely available, SC4C will improve access to care, reduce costs to the health care system and society, and ensure children receive the right care at the right time, and in the right place.”

With the potential for these results to help other countries experiencing a similar problem, the researchers hope the program will solve major problems with health care in Australia – and overseas.

Australian and international contributors to the research were from the Sydney Local Health District, South Eastern Sydney Local Health Districts, the University of Melbourne, Macquarie University, the Sydney Children’s Hospital Network and the University of Michigan.

Publications

Harriet Hiscock, Rachel O’Loughlin, Rachel Pelly, Catherine Laird, Jessica Holman, Kim Dalziel, Shaoke Lei, Douglas Boyle and Gary Freed. ‘Strengthening care for children: pilot of an integrated general practitioner–paediatrician model of primary care in Victoria, Australia,’ Australian Health Review. DOI: 10.1071/AH19177

Sonia Khano, Lena Sanci, Susan Woolfenden, Yvonne Zurynski, Kim Dalziel, Siaw-Teng Liaw, Douglas Boyl, Gary L Freed9, Cecilia Moore, Michael Hodgins, Jane Le, Tammy Meyers Morris, Stephanie Germano, Karen Wheeler, Raghu Lingam, Harriet Hiscock. ‘Strengthening Care for Children (SC4C): protocol for a stepped wedge cluster randomised controlled trial of an integrated general practitioner-paediatrician model of primary care,’ BMJ Open. DOI: 10.1136/bmjopen-2022-063449

Michael Hodgins, Yvonne Zurynski, Jade Burley, Rachel Pelly, Peter D Hibbert, Susan Woolfenden, Jane Le, Stephanie Germano, Sonia Khano, Tammy Meyers Morris, Karen Wheeler, Harriet Hiscock, Raghu Lingam. ‘Protocol for the implementation evaluation of an integrated paediatric and primary care model: Strengthening Care for Children (SC4C),’ BMJ Open. DOI: 10.1136/bmjopen-2022-063450