SUSTAIN: Strengthening Care for Children

SUSTAIN was a stepped-wedge translational trial designed to strengthen paediatric care in general practice and reduce avoidable referrals to hospital outpatient clinics and emergency departments. The project brought paediatrician support directly into primary care through a virtual model that helps GPs provide high-quality child health care closer to home.

The challenge

Referrals of children to hospital EDs and outpatient clinics have been rising. At the same time, GPs are seeing fewer paediatric cases and often report feeling less confident in managing common childhood conditions.

Our approach

Provided virtual paediatrician support to participating GP practices across urban, regional and rural NSW. The intervention included fortnightly online GP-paediatrician co-consultations, monthly case discussions and education sessions, direct weekday access to paediatricians by phone and email, and enrolment of GPs in the Sydney Child Health Program. The study used a stepped-wedge cluster RCT design.

Key goals

• Reduce GP referrals of children to hospital outpatient clinics and EDs.

• Improve GP care aligned with best practice guidelines for common childhood conditions.

• Increase GP confidence in paediatric management and navigation of the child health system.

• Improve family trust in primary care.

• Determine whether the model is cost-effective, sustainable and suitable for scale-up.

Evaluation & impact

The primary outcome examined whether SUSTAIN reduced referrals from GP practices to hospital outpatient clinics and EDs. Secondary outcomes included quality of care, GP experience and confidence, family experience of care, implementation processes, economic impact and sustainability.