Abstract

Introduction

Australia’s current healthcare system for children is neither sustainable nor equitable. As children (0–4 years) comprise the largest proportion of all primary care-type emergency department presentations, general practitioners (GPs) report feeling undervalued as an integral member of a child’s care, and lacking in opportunities for support and training in paediatric conditions. This Strengthening Care for Children (SC4C) randomised trial aims to evaluate a novel, integrated GP-paediatrician model of care, that, if effective, will improve GP quality of care, reduce burden to hospital services and ensure children receive the right care, at the right time, closer to home.

Methods and analysis

SC4C is a stepped wedge cluster randomised controlled trial (RCT) of 22 general practice clinics in Victoria and New South Wales, Australia. General practice clinics will provide control period data before being exposed to the 12-month intervention which will be rolled out sequentially each month (one clinic per state) until all 22 clinics receive the intervention. The intervention comprises weekly GP-paediatrician co-consultation sessions; monthly case discussions; and phone and email paediatrician support, focusing on common paediatric conditions. The primary outcome of the trial is to assess the impact of the intervention as measured by the proportion of children’s (0–<18 years) GP appointments that result in a hospital referral, compared with the control period. Secondary outcomes include GP quality of care; GP experience and confidence in providing paediatric care; family trust in and preference for GP care; and the sustainability of the intervention. An implementation evaluation will assess the model to inform acceptability, adaptability, scalability and sustainability, while a health economic evaluation will measure the cost-effectiveness of the intervention.

Ethics and dissemination

Human research ethics committee (HREC) approval was granted by The Royal Children’s Hospital Ethics Committee in August 2020 (Project ID: 65955) and site-specific HRECs. The investigators (including Primary Health Network partners) will communicate trial results to stakeholders and participating GPs and general practice clinics via presentations and publications.

Trial registration number

Australia New Zealand Clinical Trials Registry 12620001299998.

Details

Title
Strengthening Care for Children (SC4C): protocol for a stepped wedge cluster randomised controlled trial of an integrated general practitioner-paediatrician model of primary care
Author
Khano, Sonia 1 ; Sanci, Lena 2 ; Woolfenden, Susan 3 ; Zurynski, Yvonne 4   VIAFID ORCID Logo  ; Dalziel, Kim 5 ; Siaw-Teng Liaw 6   VIAFID ORCID Logo  ; Boyle, Douglas 7 ; Freed, Gary L 8 ; Moore, Cecilia 9 ; Hodgins, Michael 10   VIAFID ORCID Logo  ; Le, Jane 1 ; Tammy Meyers Morris 10 ; Germano, Stephanie 11 ; Wheeler, Karen 12 ; Lingam, Raghu 13 ; Hiscock, Harriet 14   VIAFID ORCID Logo 

1  Health Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia 
2  Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia 
3  Community Paediatrics, Sydney Local Health District, Sydney, New South Wales, Australia; Department of Paediatrics, University of New South Wales, Sydney, New South Wales, Australia 
4  Australian Institute of Health Innnovation, Macquarie University, Sydney, New South Wales, Australia 
5  School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia 
6  School of Public Health and Community Medicine, UNSW Australia, Fairfield, New South Wales, Australia 
7  Department of General Practice, University of Melbourne, Carlton, Victoria, Australia 
8  Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA 
9  Clinical Sciences and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia 
10  University of New South Wales, Sydney, New South Wales, Australia 
11  North Western Melbourne Primary Health Network, Melbourne, Victoria, Australia 
12  Central and Eastern Sydney Primary Health Network, Sydney, New South Wales, Australia 
13  University of New South Wales, Sydney, New South Wales, Australia; Sydney Children’s Hospitals Network, Sydney, New South Wales, Australia 
14  Health Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Health Services Research Unit, The Royal Children’s Hospital, Parkville, Victoria, Australia 
First page
e063449
Section
Paediatrics
Publication year
2022
Publication date
2022
Publisher
BMJ Publishing Group LTD
e-ISSN
20446055
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1136/bmjopen-2022-063449
ProQuest document ID
2723731144
Copyright
© 2022 Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.