Children Attending Paediatricians Study: a national prospective audit of outpatient practice from the Australian
Harriet Hiscock1, Gehan Roberts, Daryl Efron
1Royal Children's Hospital, Melbourne, VIC. harriet.hiscock@rch.org.au
Insights
Australian paediatricians manage complex cases with multiple diagnoses, often billing for single issues. This audit highlights the need for better workforce planning and training to address the complexity of paediatric care.
Area of Science:
- Paediatric Medicine
- Health Services Research
- Clinical Audit
Background:
- General paediatric outpatient practice in Australia involves diverse consultation types and management patterns.
- Understanding these practices is crucial for improving healthcare delivery and training.
Purpose of the Study:
- To audit Australian general paediatric outpatient practice.
- To analyze consultation characteristics, management patterns, diagnoses, associated factors, and billing practices.
Main Methods:
- Prospective data collection from Australian Paediatric Research Network (APRN) members.
- Standardized forms used for 8345 consultations over a 2-week period in 2008.
Main Results:
- A mean of 1.8 diagnoses per consultation, with many cases involving multiple or complex conditions.
- Attention deficit hyperactivity disorder, baby checks, and learning difficulties were common diagnoses.
- Paediatricians often billed for single diagnoses despite managing multiple issues.
Conclusions:
- Australian paediatricians encounter a wide spectrum of diagnoses, frequently complex and multiple.
- Findings can inform future research, workforce planning, and paediatrician training needs.
Objective:
To audit general paediatric outpatient practice in Australia, including consultation characteristics and management patterns, diagnoses, factors associated with diagnoses, and billing practices.
Design, Setting And Participants:
In October-November 2008, members of the Australian Paediatric Research Network (APRN; a national network of paediatricians established to facilitate multisite secondary care research) were invited to prospectively complete brief standardised data collection forms for 100 consecutive patients or all patients during a 2-week period, whichever came first.
Main Outcome Measures:
Length of consultation and type of diagnoses made; proportions recorded as having medications, investigations or referral; odds ratios for factors associated with diagnoses; and proportions of Medicare items billed.
Results:
Of 300 APRN members, 199 (66%) completed data forms for 8345 consultations in which 15 375 diagnoses were made (mean, 1.8 diagnoses per consultation); 46.0%, 30.9% and 22.8% of consultations involved 1, 2 and ≥ 3 diagnoses, respectively. New and review consultations lasted a mean of 41 (SD, 20) and 26 (SD, 15) minutes, respectively. The most common diagnoses were attention deficit hyperactivity disorder (18.3%), baby checks (9.1%), and learning difficulties (7.5%). Patients seen in 47.5% of consultations had medications (eg, prescriptions, vaccinations) recorded, and patients in 27.2% of consultations were referred elsewhere, usually to a subspecialist or psychologist (31.6% and 26.6% of referrals, respectively). Male sex of the child and owning a Health Care Card were associated with most developmental-behavioural diagnoses. Paediatricians tended to bill for single disease/non-complex consultations, even when seeing a child with multiple problems.
Conclusions:
Australian paediatricians see children with a range of diagnoses that are often multiple and complex. Our findings provide directions for future secondary care research, and may inform workforce planning and paediatricians' training requirements.
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