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Prevalence and associated skills of Australian general practice registrars seeing children with functional bowel and
Sharon Goldfeld1,2, Amanda Tapley3,4, Elodie O'Connor1
1Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
General practitioners (GPs) are well-positioned to manage childhood functional bowel and bladder issues. Paediatricians should support GPs with training and advice to improve care access for these common childhood conditions.
Area of Science:
- General Practice
- Paediatric Medicine
- Child Health
Background:
- Functional bowel and bladder problems in children are prevalent and often managed by paediatricians.
- General Practitioners (GPs) are ideally placed to manage these conditions in primary care settings.
- Understanding the skills and knowledge of GP registrars in managing these issues is crucial for improving care.
Purpose of the Study:
- To determine the prevalence of functional bowel and bladder problems managed by Australian general practice registrars.
- To assess the associated management skills and practices of these registrars.
- To inform strategies for enhancing paediatric functional bowel and bladder care within general practice.
Main Methods:
- Utilized data from the Registrar Clinical Encounters in Training (ReCEnT) study (2010-2017).
- Included analysis of paediatric consultations involving functional bowel or bladder issues.
- Examined registrar management patterns, including medication prescription and specialist referrals.
Main Results:
- Functional bowel and bladder problems constituted 1.4% of paediatric presentations managed by registrars.
- Registrars were more likely to prescribe medication for bowel issues but less likely for nocturnal enuresis.
- A relatively high rate of specialist referrals was observed for these conditions.
Conclusions:
- A small proportion of children with these common conditions are managed by registrars.
- Registrars appear to follow guidelines but refer frequently, potentially limiting access to specialist care.
- Paediatricians should collaborate with GPs through training and consultation to support local management and ensure equitable care.
Aim:
Functional bowel (constipation and faecal incontinence) and bladder (urinary incontinence and enuresis) problems in children are often treated by paediatricians yet should mostly be managed by general practitioners (GPs). To understand whether the necessary skills and knowledge are being built in general practice, this study aimed to establish the prevalence and associated skills of Australian general practice registrars managing children with functional bowel and bladder problems. Together as paediatricians and GPs, we use these data to determine how best to ensure high quality, equitable care for children.
Methods:
We drew on 16 rounds of data collection from the Registrar Clinical Encounters in Training (ReCEnT) multi-site cohort study (2010-2017) of general practice registrars' in-consultation experience. It included a measure of paediatric consultations in which a functional bowel or bladder problem was managed, as well as demographic information.
Results:
Out of 62 721 problems/diagnoses for paediatric patients (0-17 years), 844 (1.4%) were coded as functional bowel (n = 709; 1.13% (95% confidence interval, CI: 1.05-1.22)) and/or bladder (n = 135; 0.22% (95% CI: 0.18-0.25)) presentations. Registrars were more likely to prescribe medication for bowel problems (odds ratio (OR) = 2.22 (95% CI: 1.86-2.64)) than for all other problems, but less likely to prescribe medication (OR = 0.31 (95% CI: 0.18-0.52)) for night-time wetting and more likely to make a specialist referral (OR = 1.99 (95% CI: 1.22-3.25)) compared to all other problems.
Conclusions:
Only a small proportion of children with functional bowel and bladder problems were seen by registrars despite high prevalence in the community and amenability to management in the general practice setting (i.e. generally low morbidity and low complexity) versus need for specialists. Registrars appeared to be managing functional bowel and bladder problems according to evidence-based guidelines, but with relatively high levels of referral. Given the inequitable access to specialist care, paediatricians should support local general practice management of these problems. This might include (i) engaging with training programs to ensure appropriate education and (ii) liaising with individual registrars/practices to provide management advice for individual or example cases.
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