School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.
Rural Medical Education Australia, Toowoomba, Queensland, Australia.
J Paediatr Child Health. 2022 Jul;58(7):1145-1150. doi: 10.1111/jpc.15923. Epub 2022 Feb 25.
The aim of this study is to characterise the nature and caseload of general paediatric outpatient clinics in rural Queensland and to compare the findings with national data.
A retrospective clinical audit of medical records in paediatric clinics at two rural hospitals was undertaken over a 6-month period. Data extracted included demographics, diagnostic category and onward referral outcomes. The same diagnostic categories were used as the national Children Attending Paediatricians Study (CAPS) to facilitate comparison.
A total of 346 records were reviewed, 56 (16.2%) documented Aboriginal and Torres Strait Islander descent. Compared to national data, significantly more children with behavioural/developmental diagnoses were seen in the rural clinics (CAPS 33.8%; rural 59.2%; P < 0.001). In contrast, children presenting with medical conditions (CAPS 48.2%; rural 28.6%; P < 0.001) and mixed medical/developmental conditions (CAPS 17.9%; rural 12.1%; P = 0.006) were seen less frequently in the rural clinics. Referral rates from the rural sites were lower than the rates reported by CAPS for children with behavioural/developmental diagnoses (CAPS 35.9%, rural 24.9%; P = 0.002) and mixed diagnoses (CAPS 40.6%, rural 19.0%; P = 0.005), while there was no difference in referral rates for children with medical diagnoses (CAPS 16.1%, rural 18.2%; P = 0.575).
Rural paediatricians' caseloads are dominated by developmental/behavioural conditions, however children with these conditions are less likely to be referred to allied health and psychology services. The reasons for lower referral rates and specific pressures upon rural health services need to be investigated in future studies to provide better health services for rural children.
本研究旨在描述昆士兰州农村地区普通儿科门诊的性质和患者量，并将调查结果与全国数据进行比较。
对两家农村医院儿科诊所的病历进行了为期 6 个月的回顾性临床审计。提取的数据包括人口统计学、诊断类别和进一步转诊结果。为了便于比较，使用了与全国儿童就诊儿科医生研究 (CAPS) 相同的诊断类别。
共审查了 346 份记录，其中 56 份（16.2%）记录显示有原住民和托雷斯海峡岛民血统。与全国数据相比，农村诊所接诊的行为/发育障碍诊断儿童明显更多（CAPS 为 33.8%；农村为 59.2%；P<0.001）。相比之下，农村诊所接诊的患有医疗状况（CAPS 为 48.2%；农村为 28.6%；P<0.001）和混合医疗/发育障碍（CAPS 为 17.9%；农村为 12.1%；P=0.006）的儿童较少。农村诊所的转诊率低于 CAPS 报告的行为/发育障碍诊断儿童（CAPS 为 35.9%，农村为 24.9%；P=0.002）和混合诊断儿童（CAPS 为 40.6%，农村为 19.0%；P=0.005）的转诊率，而医疗诊断儿童的转诊率没有差异（CAPS 为 16.1%，农村为 18.2%；P=0.575）。
农村儿科医生的患者主要为发育/行为障碍，但这些儿童更不可能被转介到联合健康和心理服务机构。需要在未来的研究中调查较低的转诊率和农村卫生服务面临的具体压力的原因，以为农村儿童提供更好的卫生服务。
