Gary Freed

University of Melbourne | MSD · Melbourne School of Population Health

Introduction For decades, it has been recommended that children with sickle cell anemia (SCA) receive antibiotic prophylaxis to prevent serious infections and undergo transcranial Doppler (TCD) screening to identify those at highest risk of overt stroke. We assessed recent temporal trends in antibiotic prophylaxis prescription fills and TCD screeni...

Background and objectives: In 2016, the American Board of Medical Specialties (ABMS) approved pediatric hospital medicine (PHM) as the newest pediatric subspecialty. To characterize development of the field, this article aims to: (1) describe the responsibilities and practice settings of US pediatricians self-identifying as hospitalists; and (2) d...

In Reply I appreciate Turner and colleagues recognizing the limitations of their study,¹ to which I referred in my recent Editorial.² However, I posit that only noting important limitations that call into question the validity of results is insufficient. This is especially true when the action required to address the limitation is known to the auth...

Objectives: Clinical guidelines state brain computed tomography (CT) for atraumatic headache or first generalized afebrile, atraumatic seizure as nonindicated in neurologically normal children. We aimed to adapt 2 rigorously validated United States-based measures that examine overuse of CT in children with these conditions, and to determine whethe...

Objectives To assess receipt of annual flu immunization among children living with sickle cell disease (SCD). Methods Receipt of flu immunization (2014–2019) by SCD status was assessed among all Michigan children <18 years of age using the statewide immunization registry. Logistic regression was used to estimate the odds of annual flu immunization...

Inequity in physician salaries has been long recognized, especially between those who primarily perform procedures and those who do not. This is due to long-standing structural biases inherent to the payment system that assigns relative value units to specific work identified by a Current Procedural Terminology (CPT) code. The process of valuing CP...

Introduction Children with sickle cell disease are at increased risk of serious infections, many of which can be prevented by receipt of recommended immunizations. Study objectives were to (1) assess the primary immunization series coverage among children with sickle cell disease and (2) compare the coverage with that of those without sickle cell d...

To inform discussions of pediatric subspecialty workforce adequacy and characterize its pipeline, we examined trends in first-year fellows in the 14 American Board of Pediatrics (ABP)-certified pediatric medical subspecialties, 2001–2018. Data were obtained from the ABP Certification Management System. We determined, within each subspecialty, the a...

Aim To determine: (i) wait times and out‐of‐pocket costs for children attending private specialists for initial mental health appointments; and (ii) whether these differed between specialists working in metropolitan versus rural areas and in low, medium and high socio‐economic areas. Methods Prospective secret shopper study whereby a researcher po...

OBJECTIVE Despite recommendations to limit the use of neuroimaging for evaluation of minor head injury and atraumatic headache in children, many children receive unnecessary imaging without clear history or physical exam indications in the emergency department (ED) or other outpatient settings. This overuse of neuroimaging has not previously been e...

Objective The aim of this study was to assess the acceptability of a novel, integrated general practitioner (GP)-paediatrician model of care, aiming to reduce referrals to hospitals and improve primary care quality.MethodsA pre-post study was conducted with five general practice clinics in north-west Melbourne. Over 12 months, 49 GPs and 896 famili...

Objective: To develop, test, and validate the performance of ICD-10-CM claims-based case definitions for identifying children with sickle cell anemia (SCA). Data sources: Medicaid administrative claims (2016) for children <18 years with potential SCA (any D57x diagnosis code) and newborn screening records from Michigan and New York State. Study...

Background: Amid concerns about the pediatrician-scientist workforce, we hypothesized that declining numbers of pediatric subspecialists devote at least 25% of their professional time to research with fewer younger and female pediatricians engaged in research over the study period. Methods: Board-certified pediatricians enrolling online in the A...

Newly developed measures of health care quality for children with sickle cell anemia (SCA) have revealed significant performance gaps in recommended care. Historically, health systems, Medicaid health plans, and state Medicaid programs have not partnered with patients and families to improve SCA care delivery. We organized 2 novel multistakeholder...

Background: The US physician workforce includes an increasing number of women, with pediatrics having the highest percentage. In recent research on physicians, it is indicated that men earn more than women. It is unclear how this finding extends to pediatricians. Methods: We examined cross-sectional 2016 data on earnings from the American Academ...

Background: Physicians must balance career and home responsibilities, yet previous studies on work-life balance are focused primarily on work-based tasks. We examined gender discrepancies and factors related to household responsibilities and work-life balance among pediatricians. Methods: We used 2015 data from the American Academy of Pediatrics...

Introduction: Over the past two decades, Australia’s child population has grown by 12%, yet fewer children are seen by General Practitioners (GP) (Freed, 2011) and more present to emergency departments (Freed, 2015) and hospital outpatient clinics for relatively simple conditions that could be managed in primary care. We therefore aimed to co-devel...

Objective Retrospective, parent‐reported data suggest that 50% of Australian children with mental health disorders miss out on care. In a national sample, we aimed to determine the proportion receiving mental health services and associated characteristics, using prospective, objective data. Method Prospective analysis of linked Medicare Benefits S...

The transition from International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes has potentially substantial implications for quality measurement. Challenges include translating each measure by man...

BACKGROUND AND OBJECTIVES: Although national bodies have proclaimed the importance of incorporating quality improvement (QI) into the daily fabric of clinical care, the actual proportion of practicing pediatricians who participate in QI activities on an annual basis is unknown. Correspondingly little is known about pediatrician motivations for, att...

Objective: Explore pediatric residents' experiences and confidence with quality improvement (QI). Methods: Pediatric residents were surveyed nationally in July 2017 about their demographic characteristics, experiences with QI projects over the previous year, and confidence with QI skills. Descriptive statistics and distributions of each individu...

Objective: To determine: 1) the mean, median and range of fees for initial and subsequent private outpatient consultations with a general paediatrician in Australia; 2) any variation in fees and bulk billing rates between states/territories; and 3) volume of outpatient general paediatric specialist consultations relative to child population. Meth...

https://deepblue.lib.umich.edu/bitstream/2027.42/144315/2/jpc14058_am.pdf

Objectives: To determine, among pediatric residents, the timing and stability of decisions to pursue fellowship training and select a specific subspecialty, which can be used to inform strategies to better match the distribution of pediatric subspecialist with the needs of children. Study design: A longitudinal survey administered with the Gener...

Objectives: To identify trends in presentations to Victorian emergency departments (EDs) by children and adolescents for mental and physical health problems; to determine patient characteristics associated with these presentations; to assess the relative clinical burdens of mental and physical health presentations. Design: Secondary analysis of...

Introduction: Previous research on general practitioner (GP) referrals in adult populations demonstrated that patient pressure influenced referral practice. No research has been conducted to investigate how involvement of a parent influences paediatric referrals. Aim: To investigate whether GPs who report parental influence on their decision to ref...

Background: Children with sickle cell anemia (SCA) are at increased risk for invasive pneumococcal disease; antibiotic prophylaxis significantly reduces this risk. We calculated the proportion of children with SCA who received ≥300 days of antibiotic prophylaxis and identified predictors of such receipt. Methods: Children aged 3 months to 5 year...

Objective: To assess the part-time workforce and average hours worked per week among pediatric subspecialists in the 15 medical subspecialties certified by the American Board of Pediatrics. Study design: We examined data from pediatric subspecialists who enrolled in Maintenance of Certification with the American Board of Pediatrics from 2009 to...

Objective: The aim of this study was to determine the revenue to consultant physicians for private out-patient consultations. Specifically, the study determined changing patterns in revenue from 2011 to 2015 after accounting for bulk-billing rates, changes in gap fees and inflation. Methods: An analysis was performed of consultant physician Medicar...

Objectives To determine national service usage for initial and subsequent outpatient consultations with a consultant physician and any variation in service-use patterns between states and territories relative to population.Methods An analysis was conducted of consultant physician Medicare claims data from the year 2014 for an initial (item 110) and...

Aim: To determine (i) the proportion of different referral sources for new referrals to paediatric specialist outpatient clinics and (ii) any association of referral source with utilisation of additional health services. Methods: Survey of parents presenting with their child at five paediatric specialist outpatient clinics at two Melbourne publi...

Aim: To assess a national sample of Australian parental confidence in general practitioner (GP) care for illness and injury for their children. Methods: Cross-sectional, internet-based survey of a national, representative sample of parents of children birth - 17 years in Australia was used. Purposeful recruitment was used to achieve a national,...

Objective: To assess adults' perceptions regarding the health and well-being of children today relative to their own health and well-being as youth and the potential for intergenerational differences in those perceptions. Methods: A cross-sectional, internet-based survey of a nationally representative household sample. The study was conducted us...

Aim: The aims of this study were to estimate the proportion of emergency department presentations attributable to children with cerebral palsy (CP), investigate the frequency of emergency department presentations in a CP cohort, and compare emergency department presentations among children with CP with those of other children. Method: This was a...

Background and objectives: Sepsis syndrome, comprising sepsis, severe sepsis, and septic shock, is a leading cause of child mortality and morbidity, for which the delivery of time-sensitive care leads to improved survival. We aimed to describe the development and testing of quality measures for in-hospital care of pediatric sepsis syndrome. Metho...

Objective: To compare practice patterns and prescribing differences for juvenile idiopathic arthritis (JIA) between adult and pediatric rheumatologists, the perceived educational needs, and factors that enhance or impede co-management. Methods: Two parallel, cross sectional surveys focusing on JIA were administered in 2009 to a random sample of...

Background: Concerns exist regarding the adequacy of the pediatric subspecialty workforce in the United States. Data on practice patterns and job characteristics are necessary to help develop policies to ensure availability. Methods: We performed survey data analysis of all pediatric subspecialists enrolled in Maintenance of Certification in 201...

Objectives: To determine the mean, median and 10th and 90th percentile levels of fees and out-of-pocket costs to the patient for an initial consultation with a consultant physician; to determine any differences in fees and bulk-billing rates between specialties and between states and territories. Design, participants and setting: Analysis of 201...

Background: Whether general practitioner (GP) registrars have adequate exposure to, and feel confident in, managing children's health during training is unknown. Objectives: To determine the prevalence and associations of GP registrars' paediatric vs. non-paediatric consultations. Methods: Cross-sectional analysis from a cohort study of Austra...

The aim of this study was to identify motivators and barriers that paediatricians face when discharging patients from outpatient specialty care. A questionnaire was administered to outpatient care paediatricians in Victoria working in one of five speciality public hospital clinics. Questions focused on how important various motivators and barriers...

Aim: The overall aim was to investigate the feasibility and utility of linking a cerebral palsy (CP) register to an administrative data set for health services research purposes. We sought to compare CP hospital admissions to general childhood population admissions, and identify factors associated with type and frequency of admissions in a CP coho...

Objective: National health workforce data are used in workforce projections, policy and planning. If data to measure the current effective clinical medical workforce are not consistent, accurate and reliable, policy options pursued may not be aligned with Australia's actual needs. The aim of the present study was to identify any inconsistencies and...

Aim: Over the last decade, there has been a dramatic increase in the number of referrals for paediatric subspecialty care and in overall appointments (new and review) to these doctors. We sought to determine the perspective of parents regarding their role in the initiation of referrals, their preferences for follow-up and the role of general pract...

Background: Changes in the demography of Australia have resulted in changes in patterns of primary care delivery. One of these changes is that the proportion of paediatric visits has decreased. Objective: The objectives of the article are to examine patient, practice and personal factors that influence a general practitioner's (GP's) decision to...

Objective The aim of the present study was to determine the factors involved in the decision of paediatric specialists to discharge patients back to their primary care provider following referral. Return of patients to primary care, when medically appropriate, is essential to provide efficient care to children given the limited workforce of paediat...

Objectives The aim of the present study was to provide data to help clarify the public-private division of clinical care provision by doctors in Australia.Methods A secondary analysis was performed of data from the workforce survey administered by the Australian Health Practitioner Regulation Agency. The questionnaire included demographic and emplo...

Australian general practitioners (GPs) are seeing proportionally fewer paediatric patients. GPs may be increasingly relying on secondary or tertiary care physicians to provide care to children with complex, chronic conditions. Shared-care initiatives may provide a solution to the apparent increasing dependence of GPs on paediatric specialists, alth...

Aim: 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. Methods: This...

Objectives: Injuries are a significant proportion of lower urgency (triage category 4 or 5) child presentations to the EDs in metropolitan Melbourne. The purpose of the present study was to assess parental preferences and experiences regarding the treatment of lower urgency child injuries and the role of general practitioners (GPs) in such care....

Writing and reviewing abstracts for academic meetings are essential skills for any academic pediatrician. An accurate and reliable peer review process is critical for fair determination of which abstracts are accepted for presentation at these meetings. Unfortunately, studies of abstract review practices across many fields in medicine have found th...

Aim: The aim of the study was to investigate the patterns of medical service use in children with cerebral palsy (CP), taking into account child and family characteristics. Methods: Nine hundred and one parents and carers of children registered with the Victorian CP Register were invited to complete a survey. Participants were asked about their...

Importance: With transcranial Doppler (TCD) screening, we can identify children and adolescents with sickle cell anemia who are at the highest risk of stroke. An accurate claims-based method for identifying children and adolescents with sickle cell anemia was recently developed and validated that establishes the necessary groundwork to enable larg...

Background and objectives: A near vacuum exists for credible information regarding specialty-specific demography, including gender, years since training completion, current employer, academic affiliation, and hours worked in specific tasks. Understanding the current status and changes to the medical workforce and its work patterns is essential to...

Background and objective: Data describing factors associated with work-life balance, burnout, and career and life satisfaction for early career pediatricians are limited. We sought to identify personal and work factors related to these outcomes. Methods: We analyzed 2013 survey data of pediatricians who graduated residency between 2002 and 2004....

Background: Neonatal nurse practitioners (NNPs) play a vital role in the medical care of newborns and infants. There is expected to be a shortage of NNPs in the near future. Purpose: To assess the present NNP workforce and study the impact of potential policy changes to alleviate forecasted shortages. Methods: We modeled the education and work...

Background: Children in Australia are infrequent recipients of general practitioner (GP) home visits. Objective: The objective of this article is to examine whether parents who brought their child to an emergency department (ED) for a lower urgency condition had contacted a home-visiting GP prior to arriving at the ED. Methods: Electronic surv...

Objective. The aims of the present study were to determine the actual availability of private general paediatric appointments in the Melbourne metropolitan region for children with non-urgent chronic illnesses and the cost of such care. Methods. A'secret shopper' method was used. Telephone calls were made to a random sample of 47 private paediatric...

Background Over the last decade, paediatric referrals from general practitioners (GPs) to the emergency department (ED) have increased by 60% in Australia.Objective To investigate the characteristics of Victorian children referred by GPs to the ED with lower-urgency conditions.Method Data were collected from four hospital EDs in Victoria, May-Novem...

Objectives: The issues of importance in selecting a first job for new pediatric subspecialists, and their ability to find positions that match their professional and clinical goals, are unknown. The objectives were to (1) describe current employment patterns, practice characteristics, factors influencing choice of first position, and future work g...

Background: There is concern about whether general practice registrars gain sufficient exposure to, and confidence in caring for, many pae-diatric conditions during their apprenticeship training. General practice registrars' referral patterns for paediatric conditions over-all or for specific conditions, including behavioural or mental health diag...

Objective: The age band with, by far, the greatest number of ED presentations is children 0-4 years, with other paediatric age bands also among the highest. As the majority of these presentations are for lower urgency conditions, we sought to determine why parents seek ED care for their child for lower urgency conditions. Methods: A survey study...

Background: When one speaks of global health, there are few issues that actually have a health impact globally rather than in just one or more regions of the world or in a specific population. When truly thinking globally, among the most important global health issues affecting large segments of the world's populations is the persistence of vaccin...

Objective The aim of the present study was to examine factors associated with: (1) parental preference to receive follow-up care for their child from a general practitioner (GP); and (2) a decision to seek treatment when there is a slight worsening of their child's condition. Methods Parents presenting with their child at any one of five paediatric...

Two important considerations arise from this IJHPR article from Zimmerman and colleagues. First, is the question regarding what can be considered a “common” procedure in primary care and whether the designation can or should change over time. The second issue is whether it is enough for a doctor to feel comfortable doing a procedure for it to be wi...

Background: Co-payments for medical services have been a controversial topic in Australia. Objective: The aim of this study was to assess parents' perspectives on the potential impact of co-payments for general practice and emergency department (ED) services for children. Methods: A cross-sectional survey was conducted between May and November...

Aim: The aim of this paper was to study the prevalence of a regular source of primary care for Victorian children attending one of four emergency departments (EDs) and to determine associated characteristics, including ED use. Methods: Responses were collected via an electronic survey from parents attending EDs with their child (≤9 years of age)...

Background: A significant amount of attention has been paid to the increase in emergency department (ED) presentations in Australia. Ques-tions have arisen regarding whether all of those presenting to the ED are actually in need of true emergency services. Under-standing the characteristics of those patients who may be cared for in non-emergency s...

The Victorian Nurse-On-Call (NOC) service has been in use for over 8 years, though little research has been conducted investigating the service. The present study aimed to explore whether parents in Victoria presenting with their child to the ED for lower urgency conditions use the NOC before ED arrival and whether the advice given impacts their de...

Objective To determine the accuracy and reliability of triage of children in public hospital EDs using the Australasian Triage Scale (ATS). This is the first study to examine these issues in paediatric triage following the 2007 development of the Emergency Triage Education Kit (ETEK) to foster accurate and consistent application of the ATS.MethodsA...

Objective: To determine actual availability and cost of general practitioner appointments for children with conditions of low acuity and low urgency, from the perspective of the child’s family. Design, participants and setting: A “secret shopper” method, whereby research assistants posing as parents seeking appointments for mildly ill children tel...

The American Academy of Pediatrics (AAP) launched the Pediatrician Life and Career Experience Study (PLACES), a longitudinal study that tracks the personal and professional experiences of early career pediatricians, in 2012. We used a multipronged approach to develop the study methodology and survey domains and items, including review of existing l...

* Abbreviation: ACA — : Affordable Care Act Changes in health care policy, either proposed or enacted, often bring about heightened rhetoric and polarizing characterizations. Regardless of the potential availability of data to help guide policy deliberations, decisions regarding our health care system are almost always ultimately political. Such d...

The aim of this study was to describe the pattern of tertiary paediatric emergency department (ED) use in children and young people with cerebral palsy (CP). A retrospective analysis of ED data routinely collected at the two tertiary paediatric hospitals in Victoria, Australia, cross-matched with the Victorian Cerebral Palsy Register. Data pertaini...

Background Many previous studies that have investigated hospital admissions in children and young people with cerebral palsy lack information on cerebral palsy severity and complexity. Consequently, little is known about factors associated with the frequency and type of hospital admissions in this population. This study used hospital admission data...

The proportion of the newly graduated pediatric workforce that becomes hospitalists has been increasing slightly over the past decade. However, it is unknown what proportion of those who accept hospitalist positions as their first job intend to remain in the field longer term. This is important to workforce projections regarding the magnitude of th...

Concern is often expressed about the satisfaction of new physicians and the potential match of their workplace goals with available positions. We studied the interface of desired professional activities with actual initial positions. Survey study of all general pediatricians taking the 2012 General Pediatrics Certifying Examination. Of the 5210 who...

Objectives To describe patterns of ED utilisation over time, by patient age group and triage classification.Methods Secondary analysis of data from all patients presenting to EDs in Victoria utilising the Victorian Emergency Minimum Dataset (VEMD) for the years 2002–2013. The VEMD includes all hospitals in Victoria with 24 h EDs.ResultsThe absolute...

To assess the current pediatric nurse practitioner (PNP) workforce and to investigate the impact of potential policy changes to address forecasted shortages. We modeled the admission of students into nursing bachelor's programs and followed them through advanced clinical programs. Prediction models were combined with optimal decision-making to dete...

To describe the underlying clinical decision-making rationale among general pediatricians, family physicians, pediatric cardiologists and pediatric nephrologists in their approach to an adolescent with hypertension. We conducted semi-structured phone interviews with a convenience sample of physicians from the above-mentioned 4 specialties. Each par...

In contrast to family nurse practitioners and other adult nurse practitioners, the percentage of new pediatric nurse practitioners (PNPs) graduating each year has not increased. The aim of this study was to determine whether the marginal increase in the pipeline for PNPs is related to a limit in the capacity of educational programs or whether unfil...

Background Monitoring quality is an important way of understanding how the health care system is serving children and families. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Pediatric Quality Measures Program (PQMP) funded efforts to develop and enhance measures to assess care for children and adolescents. We describe...