Trends in paediatric practice in Australia: 2008 and 2013 national audits from the Australian Paediatric Research Network.

Abstract

In adult medicine, rates of investigation and prescribing appear to be increasing. Such information is lacking for paediatrics. We audited Australian paediatricians' practices in 2013 to determine changes since 2008 in: (i) conditions seen; (ii) consultation duration; (iii) imaging and pathology ordered; and (iv) prescribing. This is a patient-level prospective audit of paediatricians' secondary care practice. Between November and December 2013, members of the Australian Paediatric Research Network were invited to complete standardised forms for 100 consecutive patients or all patients seen over 2 weeks, whichever was completed first. diagnoses, consultation duration, pathology and/or imaging investigations ordered, rate of medication prescription. hierarchical linear modelling clustered at the paediatrician level. One hundred and eighty paediatricians (48% of those eligible) contributed 7102 consultations. The proportion of developmental/behavioural conditions rose from 48% (SD 31%) to 60% (SD 30%) in new and 54% (SD 28%) to 66% (SD 28%) in review consultations in 2013 compared with 2008. More paediatricians reported diagnoses of autism spectrum disorder (39-56%, P = 0.002), attention-deficit/hyperactivity disorder (47-55%, P = 0.05) and intellectual disability (18-36%, P = 0.001) in first consultations. Mean consultation duration and pathology/imaging ordering rates were stable. Prescribing rates increased from 39 to 45% of consultations for the top 10 new diagnoses and from 57 to 68% of consultations for the top 10 review diagnoses. Paediatricians are seeing more children with developmental-behavioural conditions, prescribing more and demonstrating wide variation in their practice. The latter suggests both over- and under-treatment.