Integrating preventive healthcare for children into general practice

‘More than 90% of children visit a GP every year and many visits are linked to minor illness or vaccinations – preventive healthcare can therefore be delivered over a number of visits.’
 
Dr Karyn Alexander discusses the opportunities general practice provides for children’s preventive heath, the subject of her PhD at Monash University and research that earned her a place on the finalist list for the 2019 Premier’s Awards for Health and Medical Research.
 
Dr Alexander was also the recipient of the 2018 RACGP Foundation/BOQ Specialist Research Grant, the 2013 RACGP Foundation Family Medical Care and Education Research (FMCER) Grant, and the 2011 RACGP Foundation Chris Silagy Research Scholarship for her research in the same area.
 
She believes preventive healthcare for children can be successfully integrated into general practice in ways  when the child sees their GP.
 
‘By asking reception staff to invite parents to complete short surveys, specifically validated child surveillance tools, that question how they view their own child’s health and development,’ Dr Alexander told newsGP.
 
‘These tools encourage parents to discuss concerns with the practice nurse or GP and can be scored with decision aids to provide evidence-informed pathways for subsequent care.’
 
Having worked as a GP co-owner for the last 25 years in a large, multidisciplinary health hub, which includes a collaborative innovation centre designed to connect community to health practitioners and researchers, Dr Alexander took an interest in preventive healthcare approaches and identifying gaps.
 
‘We know that early detection and intervention during the critical pre-school developmental window can powerfully alter an individual’s health trajectory, but young children are currently missing out on that core aspect of GP care – preventive healthcare,’ she said.
 
‘By the start of school, one in two children suffer dental caries, one in four are overweight and one in five are developmentally vulnerable.’
 
Dr Alexander cites the arrival of the arrival of the Healthy Kids Check (HKC) in 2008, a health assessment timed to coincide with pre-school vaccinations, as changing the way children were screened for health assessments.
 
Despite the implementation of the HKC for GPs to review all children and record aspects of their health and development being seen as important for the successful transition into school and beyond, Dr Alexander said it was ‘unfortunately not embraced by general practice’ and subsequently removed from the Medicare Benefits Schedule (MBS) in late 2015.
 
‘I wanted to discover why delivery [of children’s health assessments] was much lower than envisaged, and why in Victoria, where this work was conducted, rates lagged even further behind the other states,’ Dr Alexander said.
 
‘Leveraging this investigative data, I developed an intervention that used the HKC as a mechanism to deliver more preventive health services and, arguably, more effective preventive care to young children.’
 
Dr Alexander’s research used qualitative methods to discover and describe the beliefs, attitudes and behaviours of GPs and practice nurses, as well as parents from various socioeconomic and cultural backgrounds, when asked to consider preventive healthcare for children aged 3–5 years.
 
‘Interviews with parents of mixed backgrounds revealed that preventive healthcare was determined by birth order of the child and, as parents gained confidence, subsequent children were less likely to complete preventive health checks with community nursing services,’ she said.
 
Other findings from the interviews with parents were that cultural health beliefs, personal health practices, relationships with health providers and costs of services all impacted the uptake of health checks.  
 
‘Additionally, families who held concerns for their child’s development sought out information and support through a hierarchy of social contacts before presenting to health services,’ Dr Alexander said.
 
Further analysis and focus group discussions revealed that GPs’ views on the HKC are divided but, according to Dr Alexander, interventions could target individual practitioner behaviours and re-structure practice systems to streamline delivery of high-quality preventive health checks for children.
 
‘Intervention that incorporates evidence-based tools and makes every member of the general practice team more accountable for preventive health delivery to young children, brings future possibilities for improving the health trajectories of our most vulnerable a little closer,’ she said.
 
The 2019 Premier’s Awards for Health and Medical Research will be announced 25 March. RACGP Foundation grants and awards applications open 5 March.

Premier’s Awards preventive health RACGP Foundation research