Abstract
Background: There has been an exponential rise in the demand for hospital-based care for children. In Victoria and New South Wales (NSW), children can now wait up to 12 months to receive care at a hospital outpatient medical clinic. High-quality care provided closer to home at primary level could alleviate some of the hospital burden. Therefore, there is a need to adapt the health system to improve the management and support of children in primary care. Integrated models of care have been shown to improve children’s quality of life. However, evidence for key implementation metrics, including the acceptability of integrated models for paediatric populations, is limited. Strengthening Care for Children (SC4C) is an integrated model of care that consists of regular, shared general practitioner (GP)-paediatrician co-consulting sessions (in-person or via telehealth) and case discussions (in-person and online) held at the general practice, with email and telephone support provided by paediatricians to GPs during weekdays. This 12-month intervention with paediatrician support was implemented in 21 general practices across metropolitan Victoria and NSW. Our study aimed to identify the barriers and facilitators to the implementation of the SC4C model of care from the perspectives of providers and families.
Methods: A qualitative study was conducted as part of the mixed-methods Implementation Evaluation of the SC4C model from May 2021 to April 2023. Twenty-one focus groups were conducted with 82 GPs, 7 practice managers and 5 nursing and reception staff to discuss their experiences and perceptions of SC4C. Individual interviews were undertaken with 21 with GPs, 5 paediatricians and 13 families. We analysed the data using an iterative inductive thematic analysis.
Results: GPs found SC4C suitable for general practices and described being willing to learn and expand their role in managing children. GPs also cited improved confidence and knowledge due to participating in this model. Overall, paediatricians found this model acceptable but highlighted that successful implementation was reliant on their energy to engage and motivate GPs. Paediatricians reported enhanced understanding of general practice functioning and the strain under which GPs work. One of the most valuable aspects of the model cited by GPs and paediatricians was building trust-based relationships with a common goal of improving the care of children. Practice managers and staff felt this model of care was a great learning experience for the whole general practice. We obtained encouraging feedback from the families who expressed their satisfaction with the shared knowledge and quality of care received by the doctors. Families also highlighted that this model of care provided easy access to specialty services, reducing wait times and out-of-pocket costs. A key learning was the importance of considering the adaptability of the SC4C model to the different needs of the general practices and GPs for successful implementation.
Conclusion: This qualitative assessment demonstrated the acceptability of the SC4C model to providers and families. Future research should focus on finding strategies to ensure the long-term implementation of this or similar models of care with special consideration to the different circumstances within general practices.