None listed
Conditions
Brief summary
Across NSW and Victoria, 860,000 children, 30% of the States’ population, live in rural areas. Although 19% of these children live with a chronic illness, there are fewer GPs per capita and paediatric specialty care is often lacking. Strengthening Care for Rural Children (SC4RC), a model where paediatrician and GP’s work together in GP practices, aims to deliver and rigorously evaluate a primary health care system strengthening programme that can bridge the gaps in access to health services and health outcomes between children living in rural Australia and their urban peers. It aims to improve the health of children by increasing the capacity of the existing rural GP workforce to assess and effectively manage paediatric conditions.
Interventions
The SC4RC model of care intervention comprises of three components to be offered to all participating GPs:
(1) Paediatrician primary and secondary co-consulting sessions with GP practices.
Paediatricians will be allocated to GP practices and made available for in-person or telehealth co-consultations for half a day a week over a 11-month period. Primary consultations includes GP-paediatrician co-consultation sessions with the paediatric patient in-person or via telehealth. Secondary consultatio
The SC4RC model of care intervention comprises of three components to be offered to all participating GPs: (1) Paediatrician primary and secondary co-consulting sessions with GP practices. Paediatricians will be allocated to GP practices and made available for in-person or telehealth co-consultations for half a day a week over a 11-month period. Primary consultations includes GP-paediatrician co-consultation sessions with the paediatric patient in-person or via telehealth. Secondary consultation includes informal GP-paediatrician consultations in-person or telehealth on patient advice and/or clinical queries. The study paediatricians will preferentially see children referred by participating GPs. Paediatricians will record the nature and outcome of primary and secondary consultations provided (e.g., patient age, sex, presenting problem, patient outcome) through a secure online databased (REDCap software). (2) Dedicated weekday Paediatrician phone and email support for participating GPs. Participating GPs will have access to dedicated phone and email support from study Paediatricians throughout the intervention period on all weekdays. GPs will be able to seek same day advice on children they would normally refer to OP clinics or the ED. Paediatricians will record the number and nature of emails and phone calls received through REDCap. (3) Case based discussion Community of Practice Continuing professional development will be delivered through the Project ECHOTM (Extension for Community Healthcare Outcomes) online telementoring programme. Facilitated by UoM and WVPHN (accredited ECHO replication sites), this programme aims to create communities of practice by bringing together healthcare providers and subject matter experts using videoconference technology, brief presentations and case-based learning. The community of practice session will be held monthly with all participating GPs where they will engage in knowledge network by sharing clinical challenges and learnings from experts and peers. The project team will attend each session and record attendance as well as the nature of cases discussed. Adherence to the components of the model will be measured through weekly audit of data entries by the project team. Any missing recorded consultations and clinical notes will be followed up with each paediatrician
Sponsors
University of Melbourne
Study design
Allocation
Randomised controlled trial
Intervention model
Other
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
0 to 18 Years
Healthy volunteers
Yes
Inclusion criteria
To be included in the study, GP practices must: • Be located within either the Western Victoria PHN (WVHN) and Murrumbidgee PHN (MPHN) • Have, as a preference, Best Practice or Medical Director 3 as their practice software • Be accredited or working towards accreditation In addition, GP practices must be willing to: • Manage bookings and reminders for paediatrician appointments; • Install GRHANITE software GP extraction of medical record data • Record coded diagnosis and referral activities for all children and young people (<18 years) • Complete all evaluation requirements, including GP surveys; • Receive regular GP support visits from the project team; and • Provide protected time for staff and clinicians to participate in grant activity, e.g. case discussion sessions. We will include all GPs at participating GPs clinics who: • Sign a memorandum of understanding between the project and the practice • Sign a Consent Form • See patients aged 0-18 years • Must provide a minimum of one month of referral data We will invite all practice managers and all practice administrative staff for clinics participating in the trial. All families that present to the GP practices and receive care for their child aged 0-18 years of age during the data collection periods will be eligible to participate in the family experience surveys. In order to be invited to participate in semi-structured interviews families must present to the GP practices and receive care for their child aged 0-18 years of age during the intervention period. These family members must sign their consent to be contacted for a follow up interview in family surveys and must have attended a co-consultation with a GP and paediatrician.
Exclusion criteria
GP practices will be excluded from participating if: • Do not have any active patients aged 0-18 years attending their clinic in the past 12 months Practice managers who are also participating GPs will not be further recruited to participate as a practice manager. For families, exclusion criteria 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