Abstract
Background: Paediatric Primary Care Services in Ireland tend to operate in unidisciplinary manner, with different referral pathways, triaging systems, ICT systems and waiting lists, leading to uncoordinated care and multiple waiting lists with assessments at different times. There has been a significant increase in referrals to Primary Care, with increased demand, and recognition of children with support needs from multiple health professionals. Typically, General Paediatric medicine clinics are operated within the Acute Hospital setting, with little direct contact with Primary Care apart from referral letters.
Approach: Through Sláintecare Innovation and Integration Funding (SIIF), a pilot paediatric multidisciplinary ‘Linn Team’ was developed within a Community Health Network (CHN), serving 13,000 children and young people in West Galway City, Ireland. Linn team consists of two Psychologists, an Occupational Therapist (OT), a Speech and Language Therapist (SLT), a Social Worker, a General Paediatrician, a candidate paediatric Advanced Nurse Practitioner (cANP) with one Administrative Support Officer.
Key community and hospital stakeholders were engaged, including community Primary Care disciplines, Nurses, Community Medical Doctors, GP’s and Paediatricians. Feedback from service users was combined with input from clinicians to identify key challenges.
The focus of The Linn Team is to offer a co-ordinated team approach for children, and young people, who need more than two primary care services including paediatric medicine, and who would benefit from a collaborative ""wrap around"" approach.
A Primary Care based General Paediatric Clinic was established. Multidisciplinary caseload was collated. A monthly Drop-in MDT clinic provides assessment and pathway identification for children. A joint Paediatrician-Dietician clinic provides collaborative assessment and treatment. An Occupational Therapist and Paediatrician pathway allows for timely diagnosis of Developmental Co-ordination Disorder (DCD) and therapy post diagnosis. An Autism assessment pathway within the network is evolving, supported by increased training/staff supervision. This enabled Primary Care clinicians to collaborate and support families through the diagnostic journey with appropriate autism and child specific aftercare.
Results: The Linn Team has managed children with both medical and social complexity in Primary Care, avoiding ED presentations and admissions. Early discharge from hospital was supported with rapid follow-up in community clinic. General Paediatric Clinics have offered over 450 new appointments. Waiting times for paediatrician review reduced from 17 months (pre-pilot) to 3months (current). There has been reduction in waiting times for access to Psychology, SLT, OT and Dietetics. 17 multidisciplinary autism diagnostic assessments have been completed, 11 underway. Social Work support within primary care has bridged the gaps between agencies.
Impact: Formal feedback from children, young people and their families shows high acceptability. Families value knowing who their “team” is, and not repeating their stories multiple times. They appreciate coordinated appointments and timely access to assessment and treatment plans. Interdisciplinary collaboration increased between Primary Care and Acute Hospital services.
Implications: Each Community Health Network has a unique population and geography. There remains considerable challenges including ICT and information sharing between the community, GP and hospital systems. There is scope and benefit for integrated paediatric interdisciplinary teams like the Linn Team to be expanded nationally.