Djing.gii Gudjaagalali (children stars) school clinic; evaluation of a novel primary care led rural school based integrated model of care

There are more than 1.36 million children living in remote, rural and regional Australia. These children and young people have significantly worse health outcomes than their urban peers and experience inequities in healthcare access. This study explored and evaluated key components of the Djing.gii Gudjaagalali school based integrated care model, including access, coverage, availability, financial sustainability, unmet needs addressed and equity. General Practitioner (GP) clinical records for 105 students aged 4–17 years were analysed in this cross-sectional study to demonstrate students’ care journey through the clinic between May 10th, 2022, and June 28th, 2024. Descriptive statistics document student demographics, referral reasons, unmet need, previous, current and newly diagnosed concerns, and clinic recommendations. Students attending clinic were a higher risk group for biopsychosocial concerns, with 39.0% (95%CI 30.3–48.6%, n = 41/105) indicating previous child protection concerns and 12.4% (95% CI 7.4–20.0%, n = 13/105) currently in out-of-home care. Aboriginal and/or Torres Strait Islander students made up 45.0% (95%CI 25.8–65.8%, n = 9/20) of clinic attendees in the first year of the study, and 32.4% (95%CI 24.2–41.8%, n = 34/105) in total. Half (49.5%, 40.1–58.9%, n = 52/105) of the sample did not have access to a regular GP outside the school clinic, and only three students (2.9%, 95% CI 1.0–8.1%, n = 3/105) had current access to a paediatrician. The most common reasons for school referral were learning difficulties (79.1%, 95%CI 70.3–85.7%, n = 83/105), behavioural concerns (77.1%, 95%CI 68.2–84.1%, n = 81/105), and emotional concerns (73.3%, 95%CI 64.2–80.9%, n = 77/105). Underlying concerns were often related to pre-existing psychological trauma (31.4%, 95%CI 23.3–40.8%, n = 33/105), medical conditions (29.5%, 95%CI 21.6–38.8%, n = 31/105), or parental separation (29.5%, 95%CI 21.6–38.8%, n = 31/105), as well as previously undiagnosed conditions including ADHD (40%, 95%CI 31.1–49.6%, n = 42), medical diagnoses 33.3% (95%CI 25.0–42.8%, n = 35), and sleep difficulties (29.5%, 95%CI 21.6–38.8%, n = 31). Prior to clinic review, the proportion of students per condition with unmet needs, defined as previously diagnosed conditions not stable and requiring clinic management, plus newly diagnosed conditions, included autism spectrum disorder (85.7%, 95% CI 65.1–95.6%, n = 18/21), ADHD (71.2%, 95% CI 58.6–81.2%, n = 42/59), social concerns (69.7%, 95%CI 52.7–82.6%, n = 23/33), medical diagnoses (68.6%, 95% CI 55.0–79.7%, n = 35/51), sleep concerns (62%, 95%CI 48.2–74.1%, n = 31/50), deliberate self-harm/suicidal ideation (DSH/SI) (57.1%, 95% CI 28.9–82.3%, n = 8/14), and mental health diagnoses (56.5%, 95% CI 42.2–69.8%, n = 26/46). The average number of clinic recommendations per student was six, with 45.0% (95%CI 41.1–49.9%, n = 282/627) of these recommendations managed within the clinic or school, and 55.0% (95%CI 51.1–58.9%, n = 345/627) required external referral. The most common clinic recommendations were medication 67.6% (95%CI 58.2–75.8%, n = 71/105) and paediatrician review 61.0% (95%CI 51.4–69.7%, n = 64/105). A GP-led paediatric primary care model for school students in rural Australia, may improve access to healthcare for a rural paediatric population with high unmet health, mental health and social needs. Sustainable funding models are needed to deliver this model at scale.