TY - JOUR
AU - S. Bullock
AU - R. Lingam
AU - K. Wheeler
AU - Meyers Morris
AU - C. Miller
AU - L. Adams
AU - K. Peacock
AU - A. Christie
AU - M. Hodgins
AU - H. Hiscock
AU - L. Sanci
AU - N. Taylor
AU - C. Crespo-Gonzalez
A1 - 
AB - BACKGROUND: General practitioners (GPs) play a pivotal role in a patient's health care journey. However, demands on general practice, including complex patient management, workforce shortages, and health system fragmentation, have been shown to adversely impact the delivery of high-quality care and health outcomes. Integrated care models, particularly those that offer virtual care options, can support improved access to quality care and efficiency of health care delivery across metropolitan and rural areas. The SUSTAIN model of care was created to provide an accessible option for integrated care. It consists of centralized pediatricians supporting GPs in their practice through virtual coconsultations, virtual "lunch and learn" case discussions, and phone or email support. There is limited evaluation literature on integrated models of care being implemented in a primary care setting where the GP and family are face to face and the non-GP specialist is virtual. To address this gap, a comprehensive implementation evaluation of the SUSTAIN model of care was conducted. OBJECTIVE: This study aimed to examine what, why, and how different factors impact the uptake of the SUSTAIN model of care from the perspectives of the SUSTAIN pediatricians and metropolitan and rural GPs in New South Wales, Australia. METHODS: A qualitative study was conducted as part of a mixed methods implementation evaluation of the SUSTAIN model of care. Data were collected via recorded online focus groups and interviews with GPs, practice managers, and pediatricians at 6 and 12 months after the commencement of SUSTAIN. Data were analyzed thematically using iterative thematic analysis informed by the Consolidated Framework of Implementation Research. RESULTS: Eighteen focus groups and 13 interviews were conducted. GPs, practice managers, and pediatricians found the SUSTAIN model acceptable, with the flexibility and practicality of the model highlighted. GPs valued the learning opportunities, collaboration, and support they gained from working alongside the pediatricians. Virtual delivery through telehealth was viewed as a positive means of receiving specialist support that would otherwise be inaccessible to many practices. Increased efficiency in workflow and working at the top of scope in pediatric care as well as opportunities for meaningful professional relationships and increased family trust in GP-delivered care were recognized as key benefits that enhanced uptake. The current landscape of Australian general practice, with fee-for-service billing and workflow pressures, was recognized as a barrier to engagement with SUSTAIN. GPs and pediatricians highlighted that more appropriate remuneration to support co-consultation is vital to the sustainability and scalability of the SUSTAIN model. CONCLUSIONS: The SUSTAIN model of care expands on our understanding of the benefits of integrated GP-pediatrician models of care in general practice by demonstrating the utility of a pediatrician supporting a GP in their practice via telehealth across metropolitan and rural environments in New South Wales, Australia.
AD - Population Child Health Research Group, School of Clinical Medicine, UNSW Sydney, Building C29 HTH Level 3 North, 55 Botany St, Kensington, NSW, 2033, Australia, +61 293851000.; Sydney Children's Hospitals Network, Sydney, Australia.; Department of Paediatrics, The University of Melbourne, Melbourne, Australia.; Health Services and Economics, Murdoch Children's Research Institute, Melbourne, Australia.; Faculty of Medicine, Health and Dental Sciences, The University of Melbourne, Melbourne, Australia.; Department of General Practice and Primary Care, The University of Melbourne, Melbourne, Australia.; School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
AN - 42085669
BT - J Med Internet Res
C5 - HIT & Telehealth; Healthcare Disparities
DA - 05/2026
DO - 10.2196/86707
DP - NLM
ET - 20260505
JF - J Med Internet Res
LA - eng
N2 - BACKGROUND: General practitioners (GPs) play a pivotal role in a patient's health care journey. However, demands on general practice, including complex patient management, workforce shortages, and health system fragmentation, have been shown to adversely impact the delivery of high-quality care and health outcomes. Integrated care models, particularly those that offer virtual care options, can support improved access to quality care and efficiency of health care delivery across metropolitan and rural areas. The SUSTAIN model of care was created to provide an accessible option for integrated care. It consists of centralized pediatricians supporting GPs in their practice through virtual coconsultations, virtual "lunch and learn" case discussions, and phone or email support. There is limited evaluation literature on integrated models of care being implemented in a primary care setting where the GP and family are face to face and the non-GP specialist is virtual. To address this gap, a comprehensive implementation evaluation of the SUSTAIN model of care was conducted. OBJECTIVE: This study aimed to examine what, why, and how different factors impact the uptake of the SUSTAIN model of care from the perspectives of the SUSTAIN pediatricians and metropolitan and rural GPs in New South Wales, Australia. METHODS: A qualitative study was conducted as part of a mixed methods implementation evaluation of the SUSTAIN model of care. Data were collected via recorded online focus groups and interviews with GPs, practice managers, and pediatricians at 6 and 12 months after the commencement of SUSTAIN. Data were analyzed thematically using iterative thematic analysis informed by the Consolidated Framework of Implementation Research. RESULTS: Eighteen focus groups and 13 interviews were conducted. GPs, practice managers, and pediatricians found the SUSTAIN model acceptable, with the flexibility and practicality of the model highlighted. GPs valued the learning opportunities, collaboration, and support they gained from working alongside the pediatricians. Virtual delivery through telehealth was viewed as a positive means of receiving specialist support that would otherwise be inaccessible to many practices. Increased efficiency in workflow and working at the top of scope in pediatric care as well as opportunities for meaningful professional relationships and increased family trust in GP-delivered care were recognized as key benefits that enhanced uptake. The current landscape of Australian general practice, with fee-for-service billing and workflow pressures, was recognized as a barrier to engagement with SUSTAIN. GPs and pediatricians highlighted that more appropriate remuneration to support co-consultation is vital to the sustainability and scalability of the SUSTAIN model. CONCLUSIONS: The SUSTAIN model of care expands on our understanding of the benefits of integrated GP-pediatrician models of care in general practice by demonstrating the utility of a pediatrician supporting a GP in their practice via telehealth across metropolitan and rural environments in New South Wales, Australia.
PY - 2026
SN - 1439-4456 (Print); 1438-8871
SP - e86707
ST - A Virtual Integrated General Practitioner-Pediatrician Model of Care Implemented in Metropolitan and Rural Primary Care Settings: Qualitative Analysis of Clinician Perspectives on the SUSTAIN Model of Care
T1 - A Virtual Integrated General Practitioner-Pediatrician Model of Care Implemented in Metropolitan and Rural Primary Care Settings: Qualitative Analysis of Clinician Perspectives on the SUSTAIN Model of Care
T2 - J Med Internet Res
TI - A Virtual Integrated General Practitioner-Pediatrician Model of Care Implemented in Metropolitan and Rural Primary Care Settings: Qualitative Analysis of Clinician Perspectives on the SUSTAIN Model of Care
U1 - HIT & Telehealth; Healthcare Disparities
U3 - 10.2196/86707
VL - 28
VO - 1439-4456 (Print); 1438-8871
Y1 - 2026
ER -