title: The challenges of trying to increase preventive healthcare for children in general practice: results of a feasibility study.
abstract: BACKGROUND
  In Australia, general practice, the linchpin for delivery of preventive health care to large segments of the population, provides child-immunisation and preventive health alongside government services. Despite this, less than half of eligible children complete a Healthy Kids Check (HKC), a preschool preventative health assessment available since 2008. Using a rigorous theoretical process, the barriers that affected delivery and reduced general practitioner and practice nurse motivation to provide HKCs, were addressed. The resulting multifaceted intervention, aimed at increasing the proportion of children receiving evidence informed HKCs from general practice, was piloted to inform a future randomised controlled trial.
  
  
  METHODS
  The intervention was piloted in a before and after study at three sites located southeast of Melbourne, between February and October 2014. The HKC-intervention involved: 1) Delivery of training modules that motivated reception and clinical staff by delivering key messages about local prevalence rates and the "Core Story of Child Development" 2) Practical advice to prepare clinics for specific HKC-examinations 3) Workflow advice regarding systems that included all staff in the HKC process, and 4) Provision of a "Community Resources Folder" that enabled decision making and referrals. A major component of the intervention incorporated the promotion of structured developmental screening by the practice team using Parents' Evaluation of Developmental Status.
  
  
  RESULTS
  Twenty of 22 practitioners and practice managers agreed to join the study. Post-training questionnaires showed participants had developed their skills working with young children as a result of the training and all respondents believed they had successfully implemented standardised HKC services. Post intervention proportions of children completing HKCs significantly increased in two of the practices and quality improvements in HKC-processes were recorded across all three sites.
  
  
  CONCLUSIONS
  This pilot study confirmed the feasibility of delivering a multi-faceted intervention to increase HKCs from general practice and demonstrated that significant quality improvements could be made. Future studies need to extend the intervention to other states and research the health outcomes of HKCs.
authors.affiliation: Department of General Practice, School of Primary Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia. karyn.alexander@monash.edu.
authors.forename: Karyn E
authors.initials: KE
authors.lastname: Alexander
authors.affiliation: Department of General Practice, School of Primary Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia. bianca.brijnath@monash.edu.
authors.forename: Bianca
authors.initials: B
authors.lastname: Brijnath
authors.affiliation: Department of General Practice, School of Primary Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia. danielle.mazza@monash.edu.
authors.forename: Danielle
authors.initials: D
authors.lastname: Mazza
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D002657:Child Development; D002662:Child Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004502:Education, Medical, Continuing; D004509:Education, Nursing, Continuing; D005240:Feasibility Studies; D005500:Follow-Up Studies; D058006:General Practice / Q000193:education / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D010865:Pilot Projects; D011314:Preventive Health Services / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data*; D058996:Quality Improvement; D011795:Surveys and Questionnaires