Royal Children's Hospital, Melbourne, VIC.
Med J Aust. 2011 Apr 18;194(8):392-7. doi: 10.5694/j.1326-5377.2011.tb03028.x.
To audit general paediatric outpatient practice in Australia, including consultation characteristics and management patterns, diagnoses, factors associated with diagnoses, and billing practices.
DESIGN, SETTING AND PARTICIPANTS: In October-November 2008, members of the Australian Paediatric Research Network (APRN; a national network of paediatricians established to facilitate multisite secondary care research) were invited to prospectively complete brief standardised data collection forms for 100 consecutive patients or all patients during a 2-week period, whichever came first.
Length of consultation and type of diagnoses made; proportions recorded as having medications, investigations or referral; odds ratios for factors associated with diagnoses; and proportions of Medicare items billed.
Of 300 APRN members, 199 (66%) completed data forms for 8345 consultations in which 15 375 diagnoses were made (mean, 1.8 diagnoses per consultation); 46.0%, 30.9% and 22.8% of consultations involved 1, 2 and ≥ 3 diagnoses, respectively. New and review consultations lasted a mean of 41 (SD, 20) and 26 (SD, 15) minutes, respectively. The most common diagnoses were attention deficit hyperactivity disorder (18.3%), baby checks (9.1%), and learning difficulties (7.5%). Patients seen in 47.5% of consultations had medications (eg, prescriptions, vaccinations) recorded, and patients in 27.2% of consultations were referred elsewhere, usually to a subspecialist or psychologist (31.6% and 26.6% of referrals, respectively). Male sex of the child and owning a Health Care Card were associated with most developmental-behavioural diagnoses. Paediatricians tended to bill for single disease/non-complex consultations, even when seeing a child with multiple problems.
Australian paediatricians see children with a range of diagnoses that are often multiple and complex. Our findings provide directions for future secondary care research, and may inform workforce planning and paediatricians' training requirements.
审查澳大利亚普通儿科门诊实践，包括咨询特点和管理模式、诊断、与诊断相关的因素以及计费实践。
设计、地点和参与者：2008 年 10 月至 11 月，澳大利亚儿科研究网络（APRN；一个为促进多地点二级保健研究而建立的儿科医生国家网络）的成员被邀请前瞻性地在 2 周内完成 100 名连续患者或所有患者的简短标准数据收集表，以先到者为准。
咨询时间长短和做出的诊断类型；记录有药物、检查或转诊的比例；与诊断相关因素的比值比；和医疗保险项目计费的比例。
在 300 名 APRN 成员中，有 199 名（66%）为 8345 次就诊填写了数据表格，其中有 15375 个诊断（平均每个就诊 1.8 个诊断）；46.0%、30.9%和 22.8%的就诊分别涉及 1、2 和≥3 个诊断。新就诊和复诊的平均时间分别为 41（SD，20）和 26（SD，15）分钟。最常见的诊断是注意缺陷多动障碍（18.3%）、婴儿检查（9.1%）和学习困难（7.5%）。在 47.5%的就诊中记录了药物（如处方、疫苗接种），在 27.2%的就诊中患儿被转诊到其他地方，通常是专科医生或心理学家（转诊的分别为 31.6%和 26.6%）。患儿为男性和拥有医疗保健卡与大多数发育行为诊断相关。儿科医生倾向于为单一疾病/非复杂咨询计费，即使看到的是有多方面问题的儿童。
澳大利亚儿科医生为患有一系列诊断的儿童就诊，这些诊断通常是多方面和复杂的。我们的研究结果为未来的二级保健研究提供了方向，并可能为劳动力规划和儿科医生的培训要求提供信息。
