Strengthening Care for Children (SC4C)

Overview

What is Strengthening Care for Children?

Strengthening Care for Children (SC4C) explored how to reduce referrals to hospitals and support primary care through general practitioners (GPs) in the first Australian, multi-state trial of an integrated GP-paediatrician care model.

Following a successful pilot in 2018, the SC4C trial tested a GP-paediatrician integrated model of care compared to standard GP care.

Through this model we aimed to:

• reduce GP referrals to hospital emergency departments and outpatient clinics for children and young people <18 years
• strengthen paediatric quality of care delivered by GPs
• increase GP knowledge and confidence in the management of paediatric conditions  
• increase family trust in GP care and reduce family preference for referrals to paediatricians 
• determine factors that help or hinder the implementation of the model of care in general practice to inform adaptability and sustainability
• document the cost-effectiveness of the model of care to the healthcare system.  

What did the project involve?

SC4C was a stepped-wedge cluster randomised controlled trial of 21 general practice clinics in Victoria and New South Wales.

General practice clinics provided control period data before being exposed to the 12-month SC4C model of care, which was rolled out sequentially each month to one clinic per state.

The SC4C model of care involved:

1. A co-located paediatrician at a general practice clinic weekly/fortnightly over 12 months, providing GP-paediatrician co-consulting appointments to paediatric patients. 
2. Monthly paediatrician-led case study discussions at the practice. GPs were encouraged to bring cases for discussion with the group.
3. Weekday phone and email paediatrician support for GPs.

During the intervention, de-identified data from the electronic medical records was extracted from participating practices, using software called GRHANITE. This means in analysis, the study team can look at the patterns of referrals made, medications prescribed, and tests ordered for children at those general practices. 

In addition, GPs completed surveys before and after the intervention about their knowledge and confidence in managing paediatric patients, and were invited to take part in an interview at the end of model. 

Parents attending practices were invited to complete surveys about their confidence in GP care and preference for the SC4C model versus specialist care. 

Why is this project important?

Australia’s paediatric population has grown by 19% in the last two decades, with 53% of this growth in Victoria. While Medicare data indicates that the proportion of paediatric visits to primary care is steadily decreasing, children aged from 0 to 18 years make up the largest proportion of low urgency presentations to hospital emergency departments. 

Those low urgency presentations include: 

• upper respiratory infections
• asthma
• dermatology
• behaviour problems. 

Although these conditions can often be managed in primary care, research shows that GPs believe they lack the skills and support to manage them. 

A well-supported primary care workforce underpins the universal provision of equitable and comprehensive healthcare for children. This trial aims to determine if this can be achieved by integrating an educational relationship model between GPs and paediatricians in primary care.

The SC4C model of care could be an exemplar for scaling up nationally and adapting to other paediatric populations and primary care settings. 

Strengthening care for children with North Coburg Medical Centre