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
Abstract
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…
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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