A groundbreaking trial aimed at reducing general practice referrals to hospital-based paediatricians has been a marked success, with researchers recommending that the model be rolled out across Australia.
The trial, called Strengthening Care for Children (SC4C) was led by the Murdoch Children’s Research Institute (MCRI), assisted by researchers from the University of Melbourne, University of NSW, University of Sydney, and project facilitators from North Western Melbourne Primary Health Network (NWMPHN) and Central and Eastern Sydney Primary Health Network.
SC4C paired general practices with experienced Royal Children’s Hospital paediatricians for patient co-consultations. The paediatricians visit each clinic weekly for six months, and then fortnightly for another six months.
GPs also took part in monthly paediatrician-led case conferences, and could access daily telephone and email support.
The aim was to increase GP confidence and capacity in dealing with children with non-urgent, common conditions, thereby reducing referrals to hospital-based paediatric services.
The first pilot study for the SC4C model involved five general practices in the NWMPHN catchment. Over 12 months 49 GPs and 896 families participated.
Following a positive evaluation, second phase of the trial saw the number of participating practices boosted to 21 general practices across NWMPHN and Sydney. A total of 125 GPs conducted 96,804 consultations.
The results – published in The Medical Journal of Australia – found that after taking part in SC4C, GPs referred fewer patients to hospital outpatient clinics and emergency departments. This indicated that GPs felt more confident treating patients in their own clinics.
Furthermore, the referral rate remained low even after the paediatrician visits ceased, suggesting GPs retained confidence and capability gained through participation in the model.
“To relieve pressure on hospitals and improve equitable access to specialist care, this care model could be expanded to include general practices in areas with high numbers of children and general practitioners with high referral rates,” concluded the researchers, led by MCRI’s Professor Harriet Hiscock.
Two NWMPHN staffers – Stephanie Germano and Shurfa Buhary – were key members of the SC4C team.
Ms Germano was an author on two other papers – one outlining project evaluation protocols and the other describing the trial – which were published in British journal BMJ Open.
“It’s really encouraging to see how robust and sustainable this model turned out to be,” said Ms Germano.
“Not only did it ease the pressure on hospital-based services, it also demonstrably boosted the confidence of many of the participating GPs to deal with a lot more paediatric cases in the practice.
“This saves time and money for kids and worried parents, and means much more treatment and support close to home rather than in hospital settings.”
