Strengthening Care for Children (SC4C), an Integrated Paediatrician-General Practitioner Model for Reducing Hospital...

Area of Science:

• Primary Care Pediatrics
• Health Services Research
• Clinical Trial Methodology

Background:

• General practitioners (GPs) often refer children under 18 to hospital services.
• Optimizing primary care for children can potentially reduce unnecessary hospital referrals and improve care coordination.

Purpose of the Study:

• To evaluate the effectiveness of the Strengthening Care for Children (SC4C) intervention in decreasing GP referrals of pediatric patients to hospital services.

Main Methods:

• A stepped-wedge cluster randomized trial was conducted across general practices in Melbourne and Sydney.
• Data were collected over 16 months, involving weekly then fortnightly GP-paediatrician co-consultations and ongoing support.
• The primary outcome was the proportion of GP visits resulting in hospital referrals, analyzed overall and by baseline referral rates.

Main Results:

• The SC4C intervention led to a slight overall reduction in hospital referrals (2.3% to 1.9%).
• Practices with high baseline referral rates (≥5%) saw a significant decrease in referrals (7.3% to 3.0%) post-intervention.
• GP confidence in managing child health improved, with no adverse events reported and sustained family preference for GP-led care.

Conclusions:

• The SC4C program effectively reduces hospital referrals for children, especially from high-referring GPs.
• The intervention enhances GP confidence in pediatric care and supports the existing preference for primary care-led services.
• SC4C demonstrates a viable strategy for improving pediatric care within primary health networks.