General practitioner perspectives on a shared-care model for paediatric patients post-intensive care: A cross-sectional survey

Published:October 06, 2022DOI:



      While paediatric critical illness mortality rates in Australia are declining, the growing cohort of paediatric intensive care unit (PICU) survivors means an increasing number of children facing substantial health challenges after their discharge from intensive care. General practitioners (GPs) play a key role in provision of comprehensive health care to children and families and are ideally positioned to provide developmental surveillance and support the care of both the child and family following critical illness.


      An anonymous, cross-sectional survey of 60 GPs, reached via private invitation (19% response) or via social media weblink, was conducted where the GPs were asked about their current confidence and knowledge in managing children post PICU. This included awareness of short- and long-term problems, of paediatric intensive care syndrome in paediatrics (PICS-p), and of educational materials. Lastly, a parent-completed screening questionnaire and shared-care pathway were proposed to GPs for their feedback on perceived benefit and willingness to participate. Data were analysed using frequency distributions and chi-square statistics.


      Ninety-three percent of GPs had some level of confidence in caring for a child post PICU admission and low confidence in their knowledge of potential short- and long-term complications. Eighty percent of GPs had not heard of PICS-p, and 93% were unaware of educational materials available on this topic. Ninety-five percent of GPs perceived that the proposed patient-screening tool and shared-care pathways would be beneficial, and 70% predicted that they would definitely use educational materials if accessible through GP central repositories.


      To reduce ongoing health problems for children recovering from critical illness, the family GP plays a pivotal role in providing community-level developmental care, particularly in Australia. Increasing GP confidence and knowledge through education is essential, and using a parent-completed screening questionnaire and shared-care pathway to improve care may be beneficial. GPs must also be involved in the implementation stages of future shared-care models.


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        • Aspesberro F.
        • Mangione-Smith R.
        • Zimmerman J.J.
        Health-related quality of life following pediatric critical illness.
        Intensive Care Med. 2015; 41: 1235-1246
        • Procter C.
        • Morrow B.
        • Pienaar G.
        • Shelton M.
        • Argent A.
        Outcomes following admission to paediatric intensive care: a systematic review.
        J Paediatr Child Health. 2021; 57: 328-358
        • Herrup E.A.
        • Wieczorek B.
        • Kudchadkar S.R.
        Characteristics of postintensive care syndrome in survivors of pediatric critical illness: a systematic review.
        World J Crit Care Med. 2017; 6: 124-134
        • Choong K.
        PICU-acquired complications: the new marker of the quality of care.
        ICU Manage Practice. 2019; 19: 85-88
        • Butt W.
        What is the outcome of children admitted to intensive care? This is the most important question we need to answer!.
        Pediatr Crit Care Med. 2017; 18: 292-293
        • Mesotten D.
        • Gielen M.
        • Sterken C.
        • Claessens K.
        • Hermans G.
        • Vlasselaers D.
        • et al.
        Neurocognitive development of children 4 Years after critical illness and treatment with tight glucose control: a randomized controlled trial.
        JAMA. 2012; 308: 1641-1650
        • Pinto N.P.
        • Rhinesmith E.W.
        • Kim T.Y.
        • Ladner P.H.
        • Pollack M.M.
        Long-term function after pediatric critical illness: results from the survivor outcomes study.
        Pediatr Crit Care Med. 2017; 18: e122-e130
        • Manning J.C.
        • Pinto N.P.
        • Rennick J.E.
        • Colville G.
        • Curley M.A.Q.
        Conceptualizing post intensive care syndrome in children-the PICS-p framework.
        Pediatr Crit Care Med. 2018; 19: 298-300
        • Long D.A.
        • Fink E.L.
        Transitions from short to long-term outcomes in pediatric critical care: considerations for clinical practice.
        Transl Pediatr. 2021; 10: 2858-2874
        • Raman S.
        • Long D.
        • Gelbart B.
        • Delzoppo C.
        • Millar J.
        • Erickson S.
        • et al.
        Priorities for paediatric critical care research: a modified delphi study by the Australian and New Zealand intensive care society paediatric study group.
        Crit Care Reusc. 2021; 23: 194-201
        • Williams C.N.
        • Kirby A.
        • Piantino J.
        If you build it, they will come: initial experience with a multi-disciplinary pediatric neurocritical care follow-up clinic.
        Children (Basel, Switzerland). 2017; 4
        • Eagleson K.
        • Campbell M.
        • McAlinden B.
        • Heussler H.
        • Pagel S.
        • Webb K.-L.
        • et al.
        Congenital Heart Disease Long-term Improvement in Functional hEalth (CHD LIFE): a partnership programme to improve the long-term functional health of children with congenital heart disease in Queensland.
        J Paediatr Child Health. 2020; 56: 1003-1009
        • Bai J.
        • Gyaneshwar R.
        • Bauman A.
        Models of antenatal care and obstetric outcomes in Sydney South West.
        Aust N Z J Obstet Gynaecol. 2008; 48: 454-461
        • Emery J.D.
        • Shaw K.
        • Williams B.
        • Mazza D.
        • Fallon-Ferguson J.
        • Varlow M.
        • et al.
        The role of primary care in early detection and follow-up of cancer.
        Nat Rev Clin Oncol. 2014; 11: 38-48
        • Blaauwbroek R.
        • Zwart N.
        • Bouma M.
        • Meyboom-de Jong B.
        • Kamps W.A.
        • Postma A.
        The willingness of general practitioners to be involved in the follow-up of adult survivors of childhood cancer.
        J Cancer Surviv. 2007; 1: 292-297
        • Meacham L.R.
        • Edwards P.J.
        • Cherven B.O.
        • Palgon M.
        • Espinoza S.
        • Hassen-Schilling L.
        • et al.
        Primary care providers as partners in long-term follow-up of pediatric cancer survivors.
        J Cancer Surviv. 2012; 6: 270-277
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gøtzsche P.C.
        • Vandenbroucke J.P.
        The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.
        J Clin Epidemiol. 2008; 61: 344-349
        • The Sydney Children's hospitals Network
        The Sydney child health program.
        The Sydney Children’s Hospitals Network, 2021 (Available at)
        Date accessed: March 5, 2022
        • Brundisini F.
        • Giacomini M.
        • DeJean D.
        • Vanstone M.
        • Winsor S.
        • Smith A.
        Chronic disease patients' experiences with accessing health care in rural and remote areas: a systematic review and qualitative meta-synthesis.
        Ont Health Technol Assess Ser. 2013; 13: 1-33
        • George M.
        • Ngo P.
        • Prawira A.
        Rural oncology: overcoming the tyranny of distance for improved cancer care.
        J Oncol Pract. 2014; 10: e146-e149
        • Wakerman J.
        • Humphreys J.S.
        • Wells R.
        • Kuipers P.
        • Entwistle P.
        • Jones J.
        Primary health care delivery models in rural and remote Australia: a systematic review.
        BMC Health Serv Res. 2008; 8: 276
        • Hamilton S.
        • Mills B.
        • McRae S.
        • Thompson S.
        Evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote Western Australia.
        BMC Health Serv Res. 2018; 18: 64
        • O'Sullivan B.G.
        • Joyce C.M.
        • McGrail M.R.
        Rural outreach by specialist doctors in Australia: a national cross-sectional study of supply and distribution.
        Hum Resour Health. 2014; 12: 50
        • Thomas H.
        • Best M.
        • Mitchell G.
        Whole-person care in general practice: the doctor–patient relationship.
        Aust J Gen Pract. 2020; 49: 139-144
        • Crossley J.
        • Davies H.
        Doctors' consultations with children and their parents: a model of competencies, outcomes and confounding influences.
        Med Educ. 2005; 39: 807-819
        • HealthPathways Community
        About the healthpathways community.
        HealthPathways Community, 2022 (Available at)
        Date accessed: March 5, 2022
        • Ge J.
        • Davis A.
        • Jain A.
        A retrospective analysis of discharge summaries from a tertiary care hospital medical oncology unit: to assess compliance with documentation of recommended discharge summary components.
        Cancer Rep (Hoboken, NJ). 2022; 5: e1457
        • Maurice A.P.
        • Chan S.
        • Pollard C.W.
        • Richard A.K.
        • J Ayre S.
        • E Ward H.
        • et al.
        Improving the quality of hospital discharge summaries utilising an electronic prompting system.
        BMJ Qual Improv Rep. 2014; 3 (u200548.w2201)
        • Finlay-Jones A.
        • Varcin K.
        • Leonard H.
        • Bosco A.
        • Alvares G.
        • Downs J.
        Very early identification and intervention for infants at risk of neurodevelopmental disorders: a transdiagnostic approach.
        Child Dev Perspect. 2019; 13: 97-103
        • Halbwachs M.
        • Muller J.-B.
        • Nguyen The Tich S.
        • de La Rochebrochard E.
        • Gascoin G.
        • Branger B.
        • et al.
        Usefulness of parent-completed ASQ for neurodevelopmental screening of preterm children at five years of age.
        PLoS One. 2013; 8e71925
        • Lavallee D.C.
        • Chenok K.E.
        • Love R.M.
        • Petersen C.
        • Holve E.
        • Segal C.D.
        • et al.
        Incorporating patient-reported outcomes into health care to engage patients and enhance care.
        Health Aff. 2016; 35: 575-582
        • Hutchings O.R.
        • Dearing C.
        • Jagers D.
        • Shaw M.J.
        • Raffan F.
        • Jones A.
        • et al.
        Virtual health care for community management of patients with COVID-19 in Australia: observational cohort study.
        J Med Internet Res. 2021; 23e21064
        • White J.
        • Byles J.
        • Walley T.
        The qualitative experience of telehealth access and clinical encounters in Australian healthcare during COVID-19: implications for policy.
        Health Res Pol Syst. 2022; 20: 9
        • Ward B.
        • Humphreys J.
        • McGrail M.
        • Wakerman J.
        • Chisholm M.
        Which dimensions of access are most important when rural residents decide to visit a general practitioner for non-emergency care?.
        Aust Health Rev. 2015; 39: 121-126
        • Catzikiris N.
        • Tapley A.
        • Morgan S.
        • van Driel M.
        • Spike N.
        • Holliday E.G.
        • et al.
        Emergency department referral patterns of Australian general practitioner registrars: a cross-sectional analysis of prevalence, nature and associations.
        Aust Health Rev. 2019; 43: 21-28
        • Fatima Y.
        • Hays R.
        • Knight S.
        • Neilson A.
        • Fleming R.
        • Panaretto K.
        • et al.
        Drivers of general practice-type presentations to the emergency department in a remote outback community.
        Aust J Rural Health. 2021; 29: 391-398
        • Monaghesh E.
        • Hajizadeh A.
        The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence.
        BMC Publ Health. 2020; 20: 1193
        • Trout M.J.
        • Henson G.
        • Senthuran S.
        Characteristics and outcomes of critically ill aboriginal and/or torres strait islander patients in North Queensland.
        Anaesth Intensive Care. 2015; 43: 216-223
        • Australian Bureau of Statistics
        Census of population and housing: counts of aboriginal and torres strait islander Australians.
        Australian Bureau of Statistics, 2016 (Available at)