Perspectives of Australian general practitioners on shared care for paediatric patients

Abstract

Australian general practitioners (GPs) are seeing proportionally fewer paediatric patients. GPs may be increasingly relying on secondary or tertiary care physicians to provide care to children with complex, chronic conditions. Shared-care initiatives may provide a solution to the apparent increasing dependence of GPs on paediatric specialists, although, currently, evidence is lacking about both the prevalence and composition of shared care for children in Australia. We invited 377 GPs in Melbourne, Australia, who had referred at least two children to specialist paediatric outpatient clinics within the 2014 calendar year, to participate in a mailed survey study. Items analysed for the present report included those relating to shared-care arrangements between GPs and paediatric specialists. Responses were received from 254 GPs (response rate 67%). The majority (90%) of GPs in our study have been involved in shared-care arrangements with outpatient paediatricians. We found wide variation in the success of these arrangements, measured through the ability of GPs to establish clear roles with paediatricians. For a national discussion around shared care to be productive, clear definitions and classifications will be crucial. Future research could investigate the reasons for variability in shared care in Australia, and examine optimal shared-care arrangements for children.

Australian general practitioners’ attitudes and knowledge of sentinel lymph node biopsy in melanoma management

“…A slight majority (56%) of GPs preferred to manage patient follow-up in a shared care arrangement, which relies on good communication between the GP and specialist and clear delineation of roles. 23,24 A limitation of the present study is that it was not possible to compare the results for GPs working in skin cancer clinics against those working in general practice because of relatively few GPs from skin cancer clinics participating in the study. A third of GPs were unsure about the role of SLNB, which might be related to general lack of awareness or to conflicting information in journals and presentations on the benefits and harms of SLNB.…”

“…Resistance may also be experienced as a result of beliefs that guidelines are 'imposed' or not trusting recommendations. [23][24][25] Some people argue that SLNB is never indicated because of the lack of survival benefit; however, all evidencebased guidelines -including national (Australian, The National Comprehensive Cancer Network, British Association of Dermatologists) and international (European Society for Medical Oncology) guidelines -recommend that SLNB be considered for a melanoma >1.0 mm in thickness or >0.8 mm Breslow thickness with additional high-risk features.…”

Conquering the great divide: Rural mothers of children with chronic health conditions accessing specialist medical care for their children

“…Medical workforce in Australia including both general practitioners, medical specialist are geographical distributed along coastal areas of Australia with fewer doctors in regional, rural and remote areas of Australia compared to capital cities (Australia, 2012) Rural mothers and their children with chronic health conditions travelled substantial distances to access healthcare and support services for their children. Rural GPs, like their metropolitan counterparts, are reliant on secondary or tertiary paediatricians to provide care for children with chronic health conditions, making travel a necessary part of care (Turbitt et al, 2017). In previous studies, rural residents with complex diseases, disabilities and/or injury experienced greater difficulties accessing health care services for numerous reasons including; lack of local specialist health care and services, long waiting lists, and by-pass local care and services (Glennie et al, 2017;Goodridge et al, 2015;Dew et al, 2016;Vindrola-Padros et al, 2018).…”

Motivators and barriers for paediatricians discharging patients

“…At the primary-speciality care interface, the medical home concept relies on paediatricians to discharge patients back to their GP when appropriate, and for GPs to accept the burden of care coordination for the child. Previous Australian research shows that over one-quarter of GPs sometimes, frequently or almost always have patients who don't return after referral to an outpatient paediatrician (Turbitt et al 2016). Research from the UK suggests that inadequate communication between GPs and specialists can result in duplication of review of patients by both GPs and specialists, providing further rationale for the importance of a system supporting coordination of care (Hughes et al 2003).…”