Djing.gii Gudjaagalali (Children Stars) School Clinic; a novel primary care led Rural School Based Integrated model of care

Background 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 key components of the integrated care model, including access, coverage, availability, affordability, improved health and equity. Methods General Practitioner (GP) clinical records for 105 students aged 4–18 years were analysed to demonstrate their care journey through the clinic between May 10th, 2022, and June 30th, 2024. Descriptive statistics were used to demonstrate student demographics, referral reasons, unmet need, previous, current and newly diagnosed concerns, and clinic recommendations. Results Students attending clinic were a high-risk group, with 41.9% indicating previous child protection concerns and 13.3% currently in out-of-home care. Aboriginal and/or Torres Strait Islander students made up 45% of clinic attendees in the first year of the study, and 32.4% in total. Half (49.5%) of the sample did not have access to a regular GP outside the school clinic, and only three students (2.9%) had current access to a paediatrician. The most common school referral reasons were learning difficulties (79%), behavioural concerns (77%), and emotional concerns (73%). The underlying reasons for these concerns were often related to psychological trauma (31%), medical conditions (30%), parental separation (30%), mental health concerns (25%), Attention Deficit Hyperactivity Disorder (ADHD) (22%), domestic violence (20%), and sleep difficulties (19%). Prior to clinic review, the proportion of students per condition with unmet needs included autism spectrum disorder (85.72%), social concerns (79.31%), ADHD (71.19%), medical diagnoses (68.63%), and sleep concerns (62%). The average number of clinic recommendations per student was six, with 45% of these recommendations managed within the clinic or school, and 55% requiring external referral. The most common clinic recommendations were mental health practitioner support/referral (81.9%), medication (67.62%) and paediatrician review (60.95%). Conclusions Rural School Based Integrated Care, a GP-led paediatric primary care model for school students in rural Australia, improves 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.