A Virtual Integrated GP-Paediatrician Model of Care in Metropolitan and Rural Australia: A Qualitative Analysis of Clinician Perspectives on the SUSTAIN Model of Care. (Preprint)

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BACKGROUND General Practitioners (GPs) play a pivotal role in a patient’s health care journey. However, demands on general practice, including an aging population and complex patient management, workforce shortages and health system fragmentation, have been shown to adversely impact delivery of high-quality care and health outcomes. Integrated care models, particularly those that offer virtual care options, are one way to 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 centralised paediatricians supporting general practitioners in their practice through virtual co-consultations, virtual case discussions and phone/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 To examine what, why and how different factors impact the uptake of the SUSTAIN model of care from the perspectives of the SUSTAIN paediatricians and metropolitan and rural GPs in New South Wales (NSW), Australia. METHODS Qualitative study as part of the mixed-methods implementation evaluation of the SUSTAIN model of care. Data were collected via recorded online focus groups and interviews with general practitioners, general practice managers and paediatricians at 6- and 12-months post implementation of SUSTAIN. Data were analysed 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 paediatricians found the SUSTAIN model acceptable, with the flexibility and practicality of the model highlighted. GPs valued the learning opportunities, collaboration and support they gained working alongside the paediatricians. 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 paediatric care as well as opportunities for meaningful professional relationships and increased family trust in GP-delivered care were recognised as key benefits that enhanced uptake. The current landscape of Australian general practice, with fee-for-service billing, limited time and workflow pressures, were all recognised as barriers to engagement with the SUSTAIN model of care. GPs and paediatricians recognised the need for more appropriate remuneration to support co-consultation as 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-paediatrician models of care in general practice by demonstrating the utility of a paediatrician supporting a GP in their practice via telehealth across metropolitan and rural environments in NSW, Australia. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12623000543684 INTERNATIONAL REGISTERED REPORT RR2-10.2196/69728

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