SUSTAIN Strengthening Care for Children : Protocol for a stepped wedge cluster randomised controlled trial of a virtual integrated general practitioner–paediatrician model of primary care. (Preprint)
Authors: Meyers-Morris Tammy , Hiscock Harriet , Wheeler Karen , Miller Corin , Hu Nan , Hassan Shire Shukri , Crespo-Gonzalez Carmen , Bullock Susan , Taylor Natalie , Boyle Dougie , Sanci Lena , Lawson Kenny , Adams Louisa , Peacock Ken , Hodgins Michael , Christie Annemarie , Lingam Raghu 
Published: December 2024

BACKGROUND

Australia’s healthcare system is under pressure. Paediatric referrals to public hospital emergency (ED) and outpatient departments (OP) have increased recently, overburdening emergency services and resulting in extended waiting times for non-urgent paediatric care. Children living outside metropolitan areas are disproportionately affected.
Integrated models of care with paediatricians collaborating with general practitioners (GPs) in their practices, have been evaluated in the UK and Australia. Results are promising for quality of care improvement and reducing referrals to hospitals . GPs and paediatricians found the model feasible, knowledge- and confidence-boosting. In-person paediatric-GP support is resource intensive, limiting scalability and sustainability .

OBJECTIVE

The objectives of the SUSTAIN trial are to evaluate a virtually delivered integrated GP-paediatrician model of care to:
1.	Reduce GP paediatric referrals to hospitals ED (<18 years) (primary outcome)
2.	Improve GP delivered paediatric guideline-concordant care, GP confidence, family trust in primary care.
3.	Examine barriers and enablers for the implementation of SUSTAIN.
4.	Understand the cost of the intervention compared with standard GP care by undertaking a health economic evaluation.

METHODS

SUSTAIN uses a stepped wedge cluster randomised controlled trial (RCT) design to implement a GP-paediatrician integrated model of care delivered virtually. Participating GP practices across both metropolitan and non-metropolitan in New South Wales (NSW) are included and randomly assigned to a start time. The intervention consists of 12-month’s access to the shared GP-paediatrician consulting sessions with patients < 18 years conducted by telehealth, virtual paediatrician-led case discussions sessions, phone/email paediatrician support and complimentary access to the internationally renowned online Sydney Child Health Program (SCHP) learning platform.
GP and family surveys are collected at baseline, prior to and in the final month of the intervention. An implementation evaluation using focus group discussions with GPs and practice staff is conducted with each practice during the intervention and optional GP and family interviews offered at the end of the intervention. A health economic evaluation will explore the cost effectiveness of this model of care

RESULTS

The trial is supported through a 2.5-year New South Wales (NSW) Ministry of Health Translational Research Grants Scheme (TRGS Round 6). Human Research Ethics Committee approval was obtained in November 2022, and practice recruitment began from March 2023. Data collection commenced for all participating practices from 1 September 2023 with anticipated completion by 28 February 2025. A data analysis will commence thereafter from March 2025 with results expected to be available by 31 July 2025.

CONCLUSIONS

Positive outcomes for the SUSTAIN trial, demonstrating that virtual paediatric support for GPs in both metropolitan and non-metropolitan areas can strengthen paediatric primary care provision has the potential to influence future health policy. This innovative approach to integrated care could be rolled out across Australia and other countries with primary care-led healthcare systems facing similar challenges.

CLINICALTRIAL

The trial has been registered on the Australian New Zealand Clinical Trials Registry (AZNCTR no. ACTRN12623000543684).