The MTS is an amalgamation of several short surveys on important member-nominated topics into a single omnibus Survey.
In 2015-2016, we asked about paediatricians approach to vaccine hesitant parents, genetic microarray testing and work practices around developmental/behavioural versus medical consultations. We will use these data to inform further APRN research.
Start date: September 2015
End date: February 2016
Ethics approval: The Royal Children’s Hospital Human Research Ethics Committee (HREC#35142)
Chromosomal Microarray (CMA)
Victoria McKay, Daryl Efron, Elizabeth Palmer, Sue White, Chris Pearson, Jane Lesslie, Heidi Webster and Margie Danchin.
Genetic testing is a rapidly developing area of medicine. Chromosomal Microarray (CMA) testing is commonly ordered by paediatricians. The CMA test detects if a child has Copy Number Variants (CNVs), which are small deletions or duplications of genetic material. Some CNVs are known to be pathogenic, some are benign, and some are of uncertain or unknown significance.
The study findings suggest:
Most paediatricians (over 70%) reported ordering CMA frequently or almost always for conditions with Medicare Benefit Schedule (MBS) rebates such as intellectual disability, global developmental delay, multiple congenital anomalies and autism spectrum disorder with intellectual disability. Most CMA tests were ordered to assist with diagnosis (85%) or family planning advice (76%).
In terms of consent, less than half the paediatricians reported using a fact sheet (28%), consent form (13%), documenting verbal (47%) or written consent (12%) frequently or almost always. The most discussed topics prior to CMA testing were pathogenic CNV (77%), uncertain results (84%) and incidental findings (77%).
Most paediatricians needed assistance in interpreting CMA results and would refer onto clinical genetics services, particularly with pathogenic and uncertain findings. Results of this survey suggest great variation in paediatric practice as well as the need for clinical guidelines for CMA testing.
McKay V, Efron D, Palmer EE, White SM, Pearson C, & Danchin M. (2017). Current use of chromosomal microarray by Australian paediatricians and implications for the implementation of next generation sequencing. Journal of Paediatrics and Child Health. 53: 650–656. doi:10.1111/jpc.13523. JPCH link
Margie Danchin, Jessica Amato, Nicholas Wood, Helen Marshall & Harold Willaby
Approximately 92% of Australian children are fully vaccinated by the time they are 24 months old. However, we believe that a significant number of Australian parents have some concerns about vaccinating their children, which if not addressed may lead them to delay or exclude some vaccines, or refuse all vaccines. Through this survey we aim to find out how often paediatricians are having vaccine related discussions with families, the specific topics discussed, and the challenges faced. We are also interested to find out how confident paediatricians feel in their knowledge and skills regarding discussions with vaccine hesitant
parents. This information will be useful for the development of online training resources.
The study findings suggest:
Around 60% of paediatricians frequently or almost always have vaccine related discussions with families. The most commonly addressed topics are vaccine necessity (33%), vaccine safety (24%), general vaccine concerns (23%) and catch-up scheduled (23%). Barriers to these discussions were largely due to too many other issues to address in the consultation (54%) and lack of time (45%). Nearly all paediatricians agreed or strongly agreed that vaccines were necessary, safe, effective and that the National Immunisation Program is appropriate for children (97-98%).
A quarter of paediatricians reported not feeling confident in their vaccine-related knowledge. Most paediatricians were receptive to online training to address vaccine-related knowledge (62%) and communication skills (53%). Paediatricians were willing to spend 1 hour (47%) to 2-4 hours (48%) participating in online training. This survey highlights the need for additional training for Australian paediatricians.
Costa-Pinto, J., Willaby, H. W., Leask, J., Wood, N., Marshall, H. and Danchin, M. (2017), Vaccine discussions with parents: The experience of Australian paediatricians. Journal of Paediatrics and Child Health. doi:10.1111/jpc.13587. JPCH link
Harriet Hiscock & Gary Freed
Paediatricians seem to be seeing more children with developmental or behavioural problems than children with medical problems. This can be very time intensive. This section asks about whether or not paediatricians try to limit the number of children you see with developmental or behavioural problems and how they schedule consultations. Results will inform further research around services for children with such conditions
The study findings suggest:
Regardless of problem type (medical, developmental or behavioural), children who saw a paediatrician in private practice had a shorter wait time than those attending public outpatients or community clinics.
Medical problems had shorter wait times in private practice with 90% of paediatricians reporting seeing children within 3 months compared with 70% in public settings.
Children with developmental or behavioural problems are less likely to wait for prolonged periods in private versus public settings.
More than 1 in 5 paediatricians reported limiting their availability for new patients with developmental and behavioural problems in the previous 12 months.
Hiscock H, Gulenc A, Efron D, Freed G. Inequity in access to paediatric care for developmental and behavioural versus medical problems in Australia: a national survey. Journal of Paediatrics and Child Health.2018; 54:705-506 https://doi.org/10.1111/jpc.14058 JPCH link