A multiprofessional approach in paediatrics in a world of solo practitioners

Issue/problem: The Austrian health care system regularly shows high performance. While about 99.9% of the population is covered by the compulsory health insurance system, the system is highly fragmented with shared responsibilities for inpatient and outpatient care without cross-linking different sectors of care or different health care professions. Pediatric primary health care in Austria is mainly provided by general paediatricians in urban areas or general practitioners in rural areas in solo practises with average opening hours of 20 hours a week. This leads to high frequencies in outpatient care departments of hospitals, particularly during off-peak operational times. Description of the problem: In 2016, the first outpatient clinic for general pediatric care was launched in Vienna with opening hours seven days a week providing a multiprofessional approach covering psychologists, physiotherapists, nutritionists and trained nurses. One objective in the conceptual design is to promote cross-sector cooperation (between the Country of Vienna and the social insurance). This should contribute to the strengthening of extramural paediatric medicine and relieve the outpatient care departments of hospitals. From a patient’s perspective it further aims to improve accessibility and reduce waiting times. For the employed health professionals this new way of collaboration offers higher flexibility of working hours. Method: For the evaluation of the first outpatient clinic for general pediatric care, a comparison group of 22 other particioners for general paediatric care was formed. Results: The  evaluation showed in 2019 a considerable increase in frequencies of about 50% since the conversion into a multiprofessional outpatient clinic for general pediatric care. The goal of relieving hospital outpatient departments of hospitals by steering the flow of patients to more appropriate and cost effective outpatient services as first contact point was achieved. Patients showed significantly lower contacts to other services of primary and secondary care than the control group. Conclusion: The study reveals that the new integrated multiprofessional approach improves the provision of paediatric care in terms of effectiveness, accessibility and waiting times. We conclude that this new way of service provision could be used as role model for future development of paediatric care in Austria and Europe