Research published in the Australian Journal of General Practice (AJGP) has revealed mental health and developmental–behavioural issues such as ADHD are the most common paediatric referrals in metropolitan general practices.
But the research also revealed children at higher risk are less likely to get the care they may need.
Authors of the study of 49,932 consultations at 22 GP clinics in Victoria and New South Wales found private billing specialist GPs were around 1.7 times more likely to refer than bulk billing GPs in the sample – and most referrals were to private billing paediatric specialists.
Corresponding author, consultant paediatrician, and University of Melbourne Professor Harriet Hiscock said the study showed a clear difference in children’s access to appropriate care depending on their socioeconomic status.
She said the study showed the need for greater investment in primary care and public paediatric mental health services, as well as for integrated care between GPs and paediatricians.
“Children from lower socioeconomic areas are more likely to have mental health and developmental–behavioural problems than those from wealthier areas,” Professor Hiscock said.
“However, these children were more likely to attend bulk billing practices and received fewer referrals for specialist care.
“We need more investment in public specialist paediatric services and paediatric mental health services.
“We also need more investment in paediatric primary care, including properly funding longer GP-patient consults, funding co-consults between GPs and paediatric specialists, and empowering GPs to diagnose and treat developmental concerns such as ADHD, especially in lower socioeconomic areas.”
The governments of New South Wales, Western Australia and South Australia, have announced they will allow GPs to work to their full scope of practice to diagnose and treat ADHD. Children in Queensland have been able to access ADHD diagnosis and support for eight years.
GPs in Victoria, Tasmania and the Australian Capital Territory have also called for GPs to be able to diagnose ADHD to improve access to treatment. In Victoria, a shared care ADHD pilot is underway with GPs and paediatricians.
Royal Australian College of GPs (RACGP) Victoria Chair Dr Anita Muñoz said every child deserves access to the care they need, and the high cost of seeing a psychiatrist or paediatrician is prohibitive for many families.
“Many families simply cannot afford ADHD assessment under the current model, but early intervention can be enormously beneficial for kids who need it,” Dr Muñoz said.
“GPs and have been successfully managing children with ADHD in Queensland for eight years without issues, and it’s great to see several states come on board to allow GPs to practice to their full scope.
“The RACGP is calling for nationally uniform rules to help people access vital care, regardless of their background.”
The infant and child health-focused edition of the AJGP also provides guidance on a range of conditions – including an orbital cellulitis case study, heart murmurs, abdominal pain disorders, and head and neck pits in children.
It also provides the latest research on the use of electronic health records to support pre-conception care, the rate of low-value care, and the use of nasal balloon auto-inflation treatment for otitis media with effusion, with RACGP members able to earn CPD hours by completing a clinical challenge on children’s health articles in the issue.
As the peer-reviewed journal of the RACGP, the AJGP keeps GPs updated on the latest research and provides information to assist them in providing high quality care.
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