Public health and preventive healthcare in children: current practices of Victorian GPs and barriers to participation

Objectives: To assess general practitioners' attitudes to and involvement in child public health activities and identify barriers affecting their participation. Design: Cross-sectional written questionnaire survey of a representative sample of actively practising GPs. Setting: General practices in the State of Victoria. Participants: 840 GPs returned questionnaires (65% response rate), and, of these, 792 (94%) saw children 0-12 years. Main outcome measures: Attitudes to and involvement in public health promotion; predictive factors for GPs' involvement. Results: The odds of GPs' involvement in child public health issues were increased by being female (odds ratio [OR], 1.88), receiving basic medical qualifications outside Australia (OR, 1.55), attending continuing education and postgraduate training (OR, 1.60), and having confidence in dealing with newborns and infants (OR, 1.93) and preschool children (OR, 2.94) (both P < 0.05). Older GPs, compared with younger GPs, had significantly lower odds of involvement (P < 0.01). After adjustment, GPs had higher odds of involvement if they agreed it was important for them to take part in health promotion, or in screening and surveillance (OR, 2.76 and 1.94, respectively; P less than or equal to 0.05); and lower odds if they agreed that screening and surveillance should be mainly done by maternal and child health nurses (OR, 0.60). The most common barriers to involvement were insufficient time, inadequate financial reimbursement for long consultations, inappropriateness of raising these issues in children presenting with illness, and lack of community resources. Conclusions: Increasing GPs' involvement in child public health will require attention to barriers (time, remuneration and perceived appropriateness), continuing education and changes in workforce composition and patterns.