PAEDIATRICIANS are dealing with a large percentage of attention deficit hyperactivity disorder (ADHD) and other behavioural disorders in complex consultations, yet are generally billing families for a single disease consultation, according to a new study.

The results of the Children Attending Paediatricians Study, published in the latest issue of the Medical Journal of Australia, also found that despite the known high prevalence of childhood obesity in Australia, it appeared to be “significantly underdiagnosed”. (1)

The study involved 199 members of the Australian Paediatric Research Network, a nationwide network of paediatricians formed in 2007 to facilitate research in paediatric outpatient settings. The survey respondents completed an audit in October-November 2008 of outpatient consultation characteristics and management patterns, diagnoses, factors associated with diagnoses and billing practices. The survey covered 8345 consultations resulting in 15 375 diagnoses.

The study found the most common diagnoses were ADHD (18.3%), baby checks (9.1%) and learning difficulties (7.5%). Male sex of the child and having a Health Care Card were associated with most of the developmental-behavioural diagnoses.

An obesity diagnosis was recorded in just 226 consultations (2.7%).

It also found that although more than half the consultations involved complex consultations with two or more diagnoses, Medicare Benefits Schedule (MBS) item billing did not match these figures. It found that 2578 consultations (30.9%) had two diagnoses and 1906 (22.8%) had three or more. Yet of 7150 consultations for which MBS data were provided, only 557 (7.8%) were billed as a new complex consultation and 420 (5.9%) as a review complex consultation.

“Paediatricians see children with multiple diagnoses, and remuneration needs to account for the extra time paediatricians spend after consultations on related tasks,” the study authors said.

Lead author of the study, Dr Harriet Hiscock, a paediatrician and postdoctoral research fellow at the Centre for Community Child Health and Murdoch Childrens Research Institute at the Royal Children’s Hospital Melbourne, told MJA InSight she was not so surprised at the number of children with ADHD and learning difficulties. She said the numbers reflected the fact that most children with ADHD were cared for by paediatricians.

Dr Hiscock said the results of the survey offered opportunities for paediatricians to look at long-term outcomes for children with ADHD and to see whether they could be improved by changing the way paediatricians manage these children.

She said the relatively low number of children diagnosed with obesity in the study reflected the fact that parents often had multiple, complex concerns about their child’s health.

“Even if a child has a high body mass index, parents may not have a concern about this. Paediatricians may therefore prioritise parent concerns first within the context of a time-limited consultation,” she said.

Coauthor Dr Daryl Efron said the high proportion of consultations involving developmental and behavioural disorders reflected modern paediatrics and the fact that conditions such as ADHD were being increasingly recognised not just by doctors but also by parents, teachers and other professionals working with children.

Dr Efron, a general and developmental-behavioural paediatrician at the Centre for Community Child Health in Melbourne, said he did have some concerns about the low level of obesity diagnoses in the survey, as that reflected a missed opportunity to discuss the issue with parents.

– Kath Ryan

1. Med J Aust 2011; 194: 392-397

Posted 18 April 2011

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