title: Children Attending Paediatricians Study: a national prospective audit of outpatient practice from the Australian Paediatric Research Network.
abstract: OBJECTIVE
  To audit general paediatric outpatient practice in Australia, including consultation characteristics and management patterns, diagnoses, factors associated with diagnoses, and billing practices.
  
  
  METHODS
  In October-November 2008, members of the Australian Paediatric Research Network (APRN; a national network of paediatricians established to facilitate multisite secondary care research) were invited to prospectively complete brief standardised data collection forms for 100 consecutive patients or all patients during a 2-week period, whichever came first.
  
  
  METHODS
  Length of consultation and type of diagnoses made; proportions recorded as having medications, investigations or referral; odds ratios for factors associated with diagnoses; and proportions of Medicare items billed.
  
  
  RESULTS
  Of 300 APRN members, 199 (66%) completed data forms for 8345 consultations in which 15 375 diagnoses were made (mean, 1.8 diagnoses per consultation); 46.0%, 30.9% and 22.8% of consultations involved 1, 2 and ≥ 3 diagnoses, respectively. New and review consultations lasted a mean of 41 (SD, 20) and 26 (SD, 15) minutes, respectively. The most common diagnoses were attention deficit hyperactivity disorder (18.3%), baby checks (9.1%), and learning difficulties (7.5%). Patients seen in 47.5% of consultations had medications (eg, prescriptions, vaccinations) recorded, and patients in 27.2% of consultations were referred elsewhere, usually to a subspecialist or psychologist (31.6% and 26.6% of referrals, respectively). Male sex of the child and owning a Health Care Card were associated with most developmental-behavioural diagnoses. Paediatricians tended to bill for single disease/non-complex consultations, even when seeing a child with multiple problems.
  
  
  CONCLUSIONS
  Australian paediatricians see children with a range of diagnoses that are often multiple and complex. Our findings provide directions for future secondary care research, and may inform workforce planning and paediatricians' training requirements.
authors.affiliation: Royal Children's Hospital, Melbourne, VIC. harriet.hiscock@rch.org.au
authors.forename: Harriet
authors.initials: H
authors.lastname: Hiscock
authors.forename: Gehan
authors.initials: G
authors.lastname: Roberts
authors.forename: Daryl
authors.initials: D
authors.lastname: Efron
authors.forename: Jillian R
authors.initials: JR
authors.lastname: Sewell
authors.forename: Hannah E
authors.initials: HE
authors.lastname: Bryson
authors.forename: Anna M H
authors.initials: AM
authors.lastname: Price
authors.forename: Frank
authors.initials: F
authors.lastname: Oberklaid
authors.forename: Michael
authors.initials: M
authors.lastname: South
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Wake
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration*; D001315:Australia; D002648:Child; D002675:Child, Preschool; D054869:Clinical Audit; D005251:Fees, Medical; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010372:Pediatrics / Q000458:organization & administration*; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D011446:Prospective Studies; D012017:Referral and Consultation