None listed
Conditions
Brief summary
We aim to assess the effectiveness of a new model of care (SC4C) compared to standard GP care in: (a) reducing GP referrals to hospital emergency departments (EDs) and outpatient (OP) clinics for children and young people < 18-years; (b) increasing GP quality of care and (c) confidence in paediatric care, and (d) family trust in primary care, whilst reducing family preference for paediatrician referral; (e) cost-effectiveness and cost-benefit of SC4C; (f) the factors that help or hinder the implementation of SC4C, and; (g) the sustainability and enduring effects of SC4C on our outcomes of interest. Participants include GP practices, GPs, families that choose to participate, practice managers, administrative staff, and the study paediatricians. The trial will be implemented in a stepped-wedge design, with a new practice adopting SC4C month-by-month for the duration of 12 months in total per practice. We expect to find a 4% absolute decrease in GP referrals to ED/OP clinics, increased provision of GP care that is adherent to guidelines for 5 common exemplar conditions, a 10% improvement in GP confidence in paediatric care, and parent confidence in GP care, and a 10% reduction in family preference for paediatrician care.
Interventions
The intervention is a new model of care that aims to strengthen paediatric primary care. The 12-month intervention consists of an integrated General Practitioner (GP) and Paediatrician model of care, including:
* GP-Paediatrician co-consultations (6 months of weekly, followed by 6 months of fortnightly) with paediatric patients (<18-years). This will involve participating GPs and the study Paediatrician co-consulting with paediatric patients at the GP Practice or via telehealth for the standard
The intervention is a new model of care that aims to strengthen paediatric primary care. The 12-month intervention consists of an integrated General Practitioner (GP) and Paediatrician model of care, including: * GP-Paediatrician co-consultations (6 months of weekly, followed by 6 months of fortnightly) with paediatric patients (<18-years). This will involve participating GPs and the study Paediatrician co-consulting with paediatric patients at the GP Practice or via telehealth for the standard consultation time of 30 minutes. For paediatric patients, they will first have an appointment with a GP at the participating practice. If the GP determines that the patient needs to see a Paediatrician, they will be invited to make an appointment for a co-consultation (instead of usual practice where they would be referred to a public or private Paediatrician). The GP who attends the co-consultation will preferably be the same GP who saw the patient for their initial appointment, but this may not always be the case due to scheduling. Follow-up GP-only or co-consultation appointments or referrals to other specialists will be at the clinical discretion of the GP and Paediatrician. For the patient, the co-consultation is designed to result in the benefit of combined specialised paediatric care from the Paediatrician and the knowledge and existing relationship this patient may have with the GP. For the participating GP, the co-consultation is designed to result in a transfer of knowledge from the Paediatrician to the GP. * Monthly 60-minute case discussions held at the GP practice. GPs in the project will bring topics or patient cases they want to discuss with the Paediatrician and their colleagues. Attendees will be the SC4C Paediatrician, GPs, practices nurses, and any other health professionals who provide paediatric care in the practice including allied health practitioners. The Paeditarician will provide information and advice on care and management related to the topic or case and may direct participating health professionals to relevant resources such as research articles or clinical practice guidelines. In instances where no specific topics or cases are nominated by the participating health professionals, the Paediatrician may present on cases they have recently seen in co-consultations, common childhood conditions, or complex topics such as child protection. * Weekday phone and email support from the study Paediatrician. Participating GPs will be able to contact the study Paediatrician via telephone or email as many times as they like for the duration of the SC4C Trial within their Practice (12-months). The content of email support will depend upon the support requested by participating GPs, and will be personalised to respond to the query. As a result of the global pandemic, we will also offer the model of care via telephone/video telehealth. We are preferencing the delivery of the model of the care in the following order: 1. Face to face co consults and case discussions 2. Face to face co consults, online case discussions 3. Telehealth 2-way via telephone or video: GP/Paed in clinic, patient joins online remotely 4. Telehealth 3-way via telephone or video: GP, Paed, and patient all join online remotely As each practice has different global pandemic policies and telehealth capabilities, we will use a tailored approach. Monitoring of adherence to the intervention will occur through the study Paediatrician maintaining a comprehensive log of attendance and topics of co-consultations and case study discussion, as well as recording number and topic of phone and email support.
Sponsors
Murdoch Children's Research Institute
Study design
Allocation
Randomised controlled trial
Intervention model
Other
Primary purpose
Educational / counselling / training
Masking
Open (masking not used) (Investigator)
Eligibility
Sex/Gender
All
Healthy volunteers
Yes
Inclusion criteria
To be included in the study, GP practices must: • Be located within either the North Western Melbourne Primary Health Network or Central and Eastern Sydney Primary Health Network; • Have Best Practice or Medical Director 3 as their electronic medical record (requirement of the data collection software); • Be accredited or working towards accreditation • Have > 900 active < 18-year old patients, attending their clinic in the past 12 months GPs- Inclusion Criteria We will include all GPs at participating GPs clinics who: • Sign a Consent Form (Appendix B) • Sign a MCRI/GP practice MOU (Appendix Y) • Be accredited or working towards accreditation • Work a minimum of 2 clinical sessions per week in the practice • See patients < 18-years • Must provide a minimum of one-month control pop-up referral data or retrospective control referral data Families All paediatric patients (<18-years) that attend a participating Practice who have been invited to attend an appointment by a participating GP will be eligible to receive a co-consultation. All families that present to the GP practices and receive care for their child (<18-years) from a participating GP during the data collection periods will have their referral information and GP quality of care data extracted. All caregivers who attend an appointment for a paediatric patient in the month prior to the intervention commencing within the GP’s Practice and in the twelfth (and final) month of the intervention at that Practice will be eligible to participate in the family experience surveys. In order to be invited to participate in semi-structured interviews these family members must signal their consent to be contacted for a follow up interview in the family surveys and must have attended a co-consultation with a GP and paediatrician.
Exclusion criteria
Exclusion criteria for GP practices: • Less than 3 GPs working in the practice are willing to participate in the study, unless they met the inclusion threshold for active patients Exclusion criteria for GPs: • New GPs who join the practice during intervention and cannot provide control referral data Exclusion criteria for family participation in the survey and interview will include: • Children or young people who present to the GP practice without a parent/guardian • Insufficient capabilities to complete the survey in the offered languages
Outcome results
None listed