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General Practice. Role and experience as key providers of comprehensive health assessment for children and young people entering out-of-home care. Sonya Tremellen & Dr Hubert Van Doorn. Why is primary care best placed? . GPs most readily accessible medically qualified professionals

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general practice

General Practice

Role and experience as key providers of comprehensive health assessment for children and young people entering out-of-home care

Sonya Tremellen & Dr Hubert Van Doorn

why is primary care best placed
Why is primary care best placed?
  • GPs most readily accessible medically qualified professionals
  • GPs first point of entry in Australian health system & can identify needs & refer appropriately
  • GPs have medical skills to identify & manage breadth of health care needs across ages and stages
  • Attending GP clinic is normal, non-stigmatising experience
are gps ready and willing research findings
Are GPs ready and willing? – Research Findings
  • GPs not ready to undertake child health assessments without some changes in practice systems
  • GPs positive about potential benefits, but have ethical concerns
  • Epidemiology of child abuse and neglect not widely shared with general practice
  • GPs would welcome further training and professional development support
  • Links between the GP and child protection sector need improvement
  • GPs are wary of red-tape burden & medico-legal complications
  • Workforce and financial pressures have critical influence
  • GPs prefer health assessment to be a first step in an ongoing therapeutic relationship

Webster SM, Temple-Smith M. (in press) Children and young people in out-of-home care: are GPs ready and willing to provide comprehensive health assessments for this vulnerable group? Australian Journal of Primary Health

gp engagement field testing
9 GP Advisors from across Victoria confirmed that:

professional development module appropriate

Commissioning letter from DHS required (along with medical history)

Medical software template essential

GP provides Summary Report & Recommendations

$300 fee-for-service

Require clarity re: consent for treatment

Concern re: follow-up & continuity

GP Engagement: Field testing
the pilot process findings
The pilot – process findings
  • General Practice successfully recruited
  • 2 month turn-around is achievable
  • Medical histories arrived
  • Children & young people knew what they were there for
  • GP assessment time: 45 + minutes (average)
  • Practice Nurse assessment time: 30 minutes (average)
  • GP Report time: 30 minutes + (average)
  • GPs satisfied with remuneration

The number of referrals to GPs made by Child Protection much lower than expected (27 over 14 months)

Of the 13 GPs trained, 6 received a referral

health assessments n 24
Health assessments n=24

6 (25%) children under-immunised

3 (12%) required treatment for acute illness

Important health issues identified

20 (83%) required referral (15 different service types)

  • Paediatrician
  • Dentist
  • Renal Unit at Royal Children’s Hospital
  • Orthopaedic and Plastics Unit at Royal Children’s Hospital
  • Back X ray
  • Wellbeing Coordinator at school
  • Hepatitis C Screening test
  • Optometry
  • Audiology
  • Psychologist
  • Family Planning/sexual health
  • Podiatry
  • Educational support required for literacy and numeracy
  • Hepatitis B immunisation
  • Speech therapist
who does what pn and gp roles
Who does what? PN and GP roles

Nurses:

  • set up appointments & entered medical history into General Practice medical record
  • Checked immunisation, height, weight & some did more

GPs:

  • Established rapport
  • Comprehensive physical & behavioural examination
  • Practices work it out
  • Team work
focus group discussion
Focus Group discussion
  • Recognised complexity of client group and time required for thorough assessment
  • Highly valued the opportunity to participate given evident benefits to children & young people
  • Demonstrated the role of the practice nurse and value of teamwork in the practice
  • Identified effective ways to manage the consultation
  • Organisational issues
  • Concerns re: Follow-up
addressing enduring concerns
Addressing enduring concerns
  • Initiate and sustain GP engagement – work through GP organisations
  • Strengthen the link between health and child protection sectors
  • Support clinical governance and continuity of care
questions

Questions

Final report available from: www.gpv.org.au

Contacts: Sonya Tremellen

s.tremelle[email protected]

03 9341 5205

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