Objective The aim of this study was to assess the acceptability of a novel, integrated general practitioner (GP)–paediatrician model of care, aiming to reduce referrals to hospitals and improve primary care quality. Methods A pre-post study was conducted with five general practice clinics in north-west Melbourne. Over 12 months, 49 GPs and 896 families participated in the intervention that included weekly to fortnightly paediatrician–GP co-consultation sessions at the general practice, monthly case discussions and telephone or email clinical support for GPs. GPs and families completed surveys or interviews at three time points (before the intervention, after running the model for 4 months and at the end of the implementation). Non-identifiable consultation data were extracted from general practice medical records. Results All GPs found the model acceptable. Although not significant, there was a trend towards a lower proportion of referrals to private paediatricians after the intervention (from 34% to 20%) and emergency departments (from 19% to 12%). Outpatient clinic referrals remained steady, and then increased as the paediatrician left the clinics (31% vs 47% before and after the intervention respectively). Unnecessary prescribing of acid suppression medications decreased by 20% (from 29% to 9%). GPs reported improved confidence in paediatric care (88% vs 100% before and after the intervention respectively). Families reported increased confidence in GP care (78% vs 94% before and after the intervention respectively). Model cost estimates were A$172 above usual care per child seen in the co-consultations. Conclusions This novel model of care is acceptable to GPs and families and may improve access and quality of paediatric care. What is known about the topic? A GP–paediatrician integrated model of care appears effective in reducing hospital burden in England, but has not been implemented in Australia. What does this paper add? This pilot, an Australian first, found that a GP–paediatrician integrated model of care is feasible and acceptable in Australia’s primary healthcare system, improves GP confidence and quality of paediatric care, may reduce paediatric referrals to outpatient clinics and emergency departments and improves family confidence in, and preference for, GP care. What are the implications for practitioners? This model may reduce hospital burden and improve quality in GP paediatric care while potentially producing cost savings for families and the healthcare system.

Objective The aim of this study was to examine the level of agreement between self-and proxy-reporting of health-related quality of life (HRQoL) in children (under 18 years of age) using generic preference-based measures. Methods A systematic review of primary studies that reported agreement statistics for self and proxy assessments of overall and/or dimension-level paediatric HRQoL using generic preference-based measures was conducted. Where available, data on intraclass correlation coefficients (ICCs) were extracted to summarise overall agreement levels, and Cohen's kappa was used to describe agreement across domains. A meta-analysis was also performed to synthesise studies and estimate the level of agreement between self-and proxy-reported paediatric overall and domain-level HRQoL. Results Of the 30 studies included, 25 reported inter-rater agreement for overall utilities, while 17 reported domain-specific agreement. Seven generic preference-based measures were identified as having been applied: Health Utilities Index (HUI) Mark 2 and 3, EQ-5D measures, Child Health Utility 9 Dimensions (CHU9D), and the Quality of Well-Being (QWB) scale. A total of 45 dyad samples were included, with a total pooled sample of 3084 children and 3300 proxies. Most of the identified studies reported a poor inter-rater agreement for the overall HRQoL using ICCs. In contrast to more observable HRQoL domains relating to physical health and functioning, the inter-rater agreement was low for psychosocial-related domains, e.g., 'emotion' and 'cognition' attributes of both HUI2 and HUI3, and 'feeling worried, sad, or unhappy' and 'having pain or discomfort' domains of the EQ-5D. Parents demonstrated a higher level of agreement with children relative to health professionals. Child self-and proxy-reports of HRQoL showed lower agreement in cancer-related studies than in non-cancerrelated studies. The overall ICC from the meta-analysis was estimated to be 0.49 (95% confidence interval 0.34-0.61) with poor inter-rater agreement. Conclusion This study provides evidence from a systematic review of studies reporting dyad assessments to demonstrate the discrepancies in inter-rater agreement between child and proxy reporting of overall and domain-level paediatric HRQoL using generic preference-based measures. Further research to drive the inclusion of children in self-reporting their own HRQoL wherever possible and limiting the reliance on proxy reporting of children's HRQoL is warranted.

Background: There is a lack of psychometric evidence about pediatric health-related quality of life (HRQoL) instruments. Evidence on cost effectiveness, involving the measurement of HRQoL, is used in many countries to make decisions about pharmaceuticals, technologies, and health services for children. Additionally, valid instruments are required to facilitate accurate outcome measurement and clinical decision making. A pediatric multi instrument comparison (P-MIC) study is planned to compare the psychometric performance and measurement characteristics of pediatric HRQoL instruments. Methods: The planned P-MIC study will collect data on approximately 6100 Australian children and adolescents aged 2–18 years via The Royal Children’s Hospital Melbourne and online survey panels. Participants will complete an initial survey, involving the concurrent collection of a range of pediatric HRQoL instruments, followed by a shorter survey 2–8 weeks later, involving the collection of a subset of instruments from the initial survey. Children aged ≥7 years will be asked to self-report HRQoL. Psychometric performance will be assessed at the instrument, domain, and item level. Conclusions: This paper describes the methodology of the planned P-MIC study, including benefits, limitations, and likely challenges. Evidence from this study will guide the choice of HRQoL measures used in clinical trials, economic evaluation, and other applications.

Box 2. Presentations to Victorian public emergency departments by people aged 0-19 years with food allergy-related problems: rates per 10 000 population, by age group Box 3. Presentations to Victorian public emergency departments by people aged 0-19 years with food allergy-related problems, by hospital campus region

Aim: Non-attendance rates at paediatric hospital outpatient clinics are high; however, parent-reported reasons for non-attendance are poorly understood. We aimed to identify: (i) modifiable system and parent factors that prevent parents from attending paediatric outpatient clinic appointments with their child; and (ii) parent views on changes that could be made to reduce non-attendance. Methods: Interviews were conducted with a random sample of parents of children aged 0-18 years who did not attend scheduled new or review outpatient clinic appointments at a metro, tertiary children's hospital in Melbourne, between 1 May and 31 July 2017. Families were excluded if the principal investigator had previously cared for the child in clinic. Results: A total of 50 parents completed an interview. Common factors related to non-attendance were reported as not receiving an appointment letter (n = 13, 26%) or text reminder (n = 16, 32%); and difficulties making changes to scheduled appointments (n = 11, 22%). Parents suggested a number of ways hospitals could reduce non-attendance, including flexible clinic times, reduced waiting periods, cheaper parking, consistent text reminders of upcoming appointment and, overwhelmingly, the ability to reschedule via text, removing the need to telephone the hospital. Conclusions: The principal reasons families struggle to attend appointments is being unaware of appointments, not receiving letters or text reminders. The lack of correct contact details held by the hospital's electronic medical record suggest systems errors in communication are impacting attendance rates of children in the clinics, and that addressing these internal issues may increase clinic attendance rates.