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Australian paediatricians and the new morbidity: a national survey of changing paediatric practice patterns
1Department of Ambulatory Paediatrics, Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Australian general paediatricians report a shift towards ambulatory care and increased cases of the "new morbidity." Paediatric practice is evolving, with less time spent on inpatients and more on community-based conditions.
Area of Science:
- Paediatric Medicine
- Public Health
- Healthcare Practice
Background:
- The practice of general paediatrics is widely assumed to be evolving.
- There is a perception of increased focus on ambulatory and community care.
- Conditions comprising the 'new morbidity' are thought to be more prevalent.
Purpose of the Study:
- To survey general paediatricians across Australia regarding their practice patterns.
- To determine if paediatric practice reflects a shift towards ambulatory care and the 'new morbidity'.
- To assess changes in the types of conditions managed by paediatricians over the past five years.
Main Methods:
- A 10-page questionnaire was mailed to general paediatricians listed in the Australian College of Paediatrics directory.
- 224 questionnaires were returned, yielding a response rate of 80.9%.
- Respondents reported time allocation to inpatient care and patient numbers for specific conditions.
Main Results:
- Only 6.8% of paediatricians spent over half their time on inpatient care; 60% spent less than one-fifth.
- Paediatricians in capital cities showed a trend towards more inpatient work (P = 0.007).
- Strong evidence indicated an increase in children with 'new morbidity' conditions and a decrease in those with organic disease over five years.
Conclusions:
- Consultant paediatric practice in Australia is predominantly non-inpatient based.
- There is a significant increase in the presentation of 'new morbidity' conditions to paediatricians.
- Paediatric practice is indeed changing, with a greater emphasis on ambulatory and community care.
Abstract:
General paediatricians across Australia were surveyed to determine whether their practice reflected the commonly held assumption that paediatrics was changing, with an increased emphasis on ambulatory and community care and involvement with conditions comprising the new morbidity. A 10 page questionnaire was mailed to every paediatrician in the Australian College of Paediatrics directory of members considered to be practising general paediatrics. Of a total of 287 questionnaires distributed, 224 were returned (response rate 80.9%). Two-thirds of respondents practised in a capital city, while the remaining third were divided equally between isolated paediatricians and those who practised in a provincial city. Only 15 paediatricians (6.8%) spent more than half their time involved in inpatient care, while 60% spent less than one-fifth of their time with inpatients. There was no correlation between inpatient involvement and length of paediatric practice, but surprisingly there was a significant trend (P = 0.007) for paediatricians practising in a capital city to do more inpatient work. Respondents were provided with a list of eight conditions held commonly to comprise the new morbidity, and there was a strong response indicating an increase in children seen with these conditions over the past 5 years, as well as a decrease in children with clearly identifiable organic disease. Furthermore, respondents indicated in absolute terms the numbers of patients seen in the past month with each of the conditions. Results confirmed the significant numbers of children seen with conditions comprising the new morbidity, their increased presentation to paediatricians in the past 5 years and the predominance of non-inpatient work in consultant paediatric practice in Australia.