An Australian pilot study involving 896 families has found that paediatricians embedded into GP clinics reduced emergency department referrals and unnecessary prescriptions. The program, run in north west Melbourne, also boosted GP's confidence in treating common childhood conditions.

The study found this model of care saves families about $153,216 over 12 months in less time off work and reduced travel costs for hospital appointments and ED visits.

The research was a collaborative effort between the Murdoch Children's Research Institute (MCRI), The Royal Children's Hospital, North Western Melbourne Primary Health Network, Western Health (Sunshine Hospital), and Werribee Mercy Hospital and published in the Australian Health Review. 

Lead author MCRI's Professor Harriet Hiscock said the approach was a new concept in Australian healthcare.

"GPs reported improved confidence in their ability to care for children in the short term, and follow up over the longer term. Families developed increased trust in and preference for GP care," Professor Hiscock said.  

"It also provided an opportunity to discuss general approaches to caring for sick kids, parent reassurance and complex family dynamics such as child protection." 

Professor Hiscock said the model of care also led to fewer unnecessary tests and prescriptions.

"There were fewer referrals to private paediatricians and emergency departments, while outpatient clinic referrals remained steady. However, these increased as the paediatrician left the clinics," she said. Some of the children needed ongoing management by a paediatrician, so needed to be referred on once the paediatrician left the clinic.

"Unnecessary prescribing of acid suppression medications to help treat reflux or unsettled behaviour in infants reduced by 20 per cent with unnecessary steroid or antibiotic prescriptions for bronchitis decreasing by 9 per cent."  

The Victorian Government's Better Care Victoria Innovation Fund, North Western Melbourne Primary Health Network, and The Royal Children's Hospital jointly funded the implementation of the project.  

Australia's paediatric population (children under 18 years) has grown by 855,215 over the past two decades. Despite this, GPs are seeing children for fewer and shorter consultations.

In Victoria, the number of children attending emergency departments over the same time has increased, with those aged 0-4 years old comprising the largest group. Waiting times for outpatient clinics are also increasing. 

Professor Hiscock said they would now trial an expanded program across 22 clinics in Victoria and NSW to test the model's sustainability and clinical and cost-effectiveness.

Researchers from the University of Melbourne and the University of Michigan also contributed to the findings.

Publication: 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 GP-paediatrician model of primary care in Victoria,' Australian Health Review. DOI: 10.1071/AH19177

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