TY - JOUR
AU - Meyers Morris
AU - H. Hiscock
AU - K. Wheeler
AU - C. Miller
AU - N. Hu
AU - Hassan Shire
AU - C. Crespo-Gonzalez
AU - S. Bullock
AU - N. Taylor
AU - D. Boyle
AU - L. Sanci
AU - K. Lawson
AU - L. Adams
AU - K. Peacock
AU - M. Hodgins
AU - A. Christie
AU - R. Lingam
A1 - 
AB - BACKGROUND: Australia's health care system is under pressure. Pediatric referrals to public hospital emergency and outpatient departments have increased recently, overburdening emergency services and resulting in extended waiting times for nonurgent pediatric care. Children living outside metropolitan areas are disproportionately affected. Integrated models of care with pediatricians collaborating with general practitioners (GPs) in their practices have been evaluated in the United Kingdom and Australia. Results are promising for quality of care improvement and reducing referrals to hospitals. GPs and pediatricians found the model feasible, knowledge- and confidence-boosting. In-person pediatric-GP support is resource-intensive, limiting scalability and sustainability. OBJECTIVE: The SUSTAIN trial is designed to evaluate a digitally delivered, integrated GP-pediatrician model of care. The primary objective is to determine whether the SUSTAIN model reduces GP referrals to hospital emergency departments for children <18 years. Secondary objectives include whether the model improves the delivery of guideline-concordant pediatric care by GPs, enhances GP confidence, and strengthens family trust in primary care. The trial also examines barriers and enablers to the implementation and includes a health economic evaluation comparing intervention costs with standard GP care. METHODS: SUSTAIN uses a stepped wedge cluster randomized controlled trial design to implement a GP-pediatrician integrated model of care delivered digitally. Participating GP practices across metropolitan and nonmetropolitan New South Wales are included and randomly assigned a start time. The intervention consists of 12 months' access to the shared GP-pediatrician consulting sessions with patients younger than 18 years conducted by telehealth, virtual pediatrician-led case discussions, phone/email pediatrician support, and complimentary access to the internationally renowned Sydney Child Health Program learning platform. GP and family surveys are collected at baseline and in the final month of intervention. An implementation evaluation using focus group discussions is conducted with each practice during the intervention and optional GP and family interviews 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 Ministry of Health Translational Research Grants Scheme. Human Research Ethics Committee approval was obtained in November 2022, and practice recruitment began in March 2023. Data collection commenced for all participating practices from September 1, 2023, with anticipated completion on February 28, 2025. Data analysis will commence from March 2025, with results expected in the first quarter of 2026. CONCLUSIONS: Positive outcomes for the SUSTAIN trial, demonstrating that virtual pediatric support for GPs in both metropolitan and nonmetropolitan areas can strengthen pediatric primary care provision, have 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 health care systems facing similar challenges.
AD - Population Child Health Research Group, Discipline of Paediatrics & Child Health, School of Clinical Medicine, University of New South Wales, Building C29 HTH Level 3, 55 Botany St Kensington, Sydney, NSW, 2033, Australia, 61 0452494461.; Health Services and Economics, Murdoch Children's Research Institute, Melbourne, Australia.; Department of Paediatrics, University of Melbourne, Melbourne, Australia.; Implementation to Impact, School of Population Health, University of New South Wales, Sydney, Australia.; Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia.; Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia.; Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia.; Sydney Children's Hospitals Network, Sydney, Australia.
AN - 41540794
BT - JMIR Res Protoc
C5 - Healthcare Disparities; Education & Workforce
DA - Jan 14
DO - 10.2196/69728
DP - NLM
ET - 20260114
JF - JMIR Res Protoc
LA - eng
N2 - BACKGROUND: Australia's health care system is under pressure. Pediatric referrals to public hospital emergency and outpatient departments have increased recently, overburdening emergency services and resulting in extended waiting times for nonurgent pediatric care. Children living outside metropolitan areas are disproportionately affected. Integrated models of care with pediatricians collaborating with general practitioners (GPs) in their practices have been evaluated in the United Kingdom and Australia. Results are promising for quality of care improvement and reducing referrals to hospitals. GPs and pediatricians found the model feasible, knowledge- and confidence-boosting. In-person pediatric-GP support is resource-intensive, limiting scalability and sustainability. OBJECTIVE: The SUSTAIN trial is designed to evaluate a digitally delivered, integrated GP-pediatrician model of care. The primary objective is to determine whether the SUSTAIN model reduces GP referrals to hospital emergency departments for children <18 years. Secondary objectives include whether the model improves the delivery of guideline-concordant pediatric care by GPs, enhances GP confidence, and strengthens family trust in primary care. The trial also examines barriers and enablers to the implementation and includes a health economic evaluation comparing intervention costs with standard GP care. METHODS: SUSTAIN uses a stepped wedge cluster randomized controlled trial design to implement a GP-pediatrician integrated model of care delivered digitally. Participating GP practices across metropolitan and nonmetropolitan New South Wales are included and randomly assigned a start time. The intervention consists of 12 months' access to the shared GP-pediatrician consulting sessions with patients younger than 18 years conducted by telehealth, virtual pediatrician-led case discussions, phone/email pediatrician support, and complimentary access to the internationally renowned Sydney Child Health Program learning platform. GP and family surveys are collected at baseline and in the final month of intervention. An implementation evaluation using focus group discussions is conducted with each practice during the intervention and optional GP and family interviews 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 Ministry of Health Translational Research Grants Scheme. Human Research Ethics Committee approval was obtained in November 2022, and practice recruitment began in March 2023. Data collection commenced for all participating practices from September 1, 2023, with anticipated completion on February 28, 2025. Data analysis will commence from March 2025, with results expected in the first quarter of 2026. CONCLUSIONS: Positive outcomes for the SUSTAIN trial, demonstrating that virtual pediatric support for GPs in both metropolitan and nonmetropolitan areas can strengthen pediatric primary care provision, have 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 health care systems facing similar challenges.
PY - 2026
SN - 1929-0748
SP - e69728
ST - Strengthening Care for Children Using a Virtual Integrated General Practitioner-Pediatrician Model of Primary Care (SUSTAIN): Protocol for a Stepped Wedge Cluster Randomized Controlled Trial
T1 - Strengthening Care for Children Using a Virtual Integrated General Practitioner-Pediatrician Model of Primary Care (SUSTAIN): Protocol for a Stepped Wedge Cluster Randomized Controlled Trial
T2 - JMIR Res Protoc
TI - Strengthening Care for Children Using a Virtual Integrated General Practitioner-Pediatrician Model of Primary Care (SUSTAIN): Protocol for a Stepped Wedge Cluster Randomized Controlled Trial
U1 - Healthcare Disparities; Education & Workforce
U3 - 10.2196/69728
VL - 15
VO - 1929-0748
Y1 - 2026
ER -