Assessing appropriateness of paediatric asthma management

a population-based sample survey

Nusrat Homaira, Louise K. Wiles, Claire Gardner, Charlotte J. Molloy, Gaston Arnolda, Hsuen P. Ting, Peter Hibbert, Claire Boyling, Jeffrey Braithwaite*, Adam Jaffe, CareTrack Kids Investigative Team

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and objective: We conducted a comprehensive assessment of guideline adherence in paediatric asthma care, including inpatient and ambulatory services, in Australia. Methods: National and international clinical practice guidelines (CPG) relating to asthma in children were searched and 39 medical record audit indicator questions were developed. Retrospective medical record review was conducted across hospital inpatient admissions, emergency department (ED) presentations, general practice (GP) and paediatrician consultations in three Australian states for children aged ≤15 years receiving care in 2012 and 2013. Eligibility of, and adherence to, indicators was assessed from medical records by nine experienced and purpose-trained paediatric nurses (surveyors). Results: Surveyors conducted 18 453 asthma indicator assessments across 1600 visits for 881 children in 129 locations. Overall, the adherence for asthma care across the 39 indicators was 58.1%, with 54.4% adherence at GP (95% CI: 46.0–62.5), 77.7% by paediatricians (95% CI: 40.5–97.0), 79.9% in ED (95% CI: 70.6–87.3) and 85.1% for inpatient care (95% CI: 76.7–91.5). For 14 acute asthma indicators, overall adherence was 56.3% (95% CI: 47.6–64.7). Lowest adherences were for recording all four types of vital signs in children aged >2 years presenting with asthma attack (15.1%, 95% CI: 8.7–23.7), and reviewing patients’ compliance, inhaler technique and triggers prior to commencing a new drug therapy (20.5%, 95% CI: 10.1–34.8). Conclusion: The study demonstrated differences between existing care and CPG recommendations for paediatric asthma care in Australia. Evidence-based interventions to improve adherence to CPG may help to standardize quality of paediatric asthma care and reduce variation of care.

Original languageEnglish
Pages (from-to)71-79
Number of pages9
JournalRespirology
Volume25
Issue number1
Early online date20 Jun 2019
DOIs
Publication statusPublished - Jan 2020

Keywords

  • asthma
  • asthma management guidelines
  • paediatric asthma
  • paediatrics

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  • Projects

    The appropriateness of healthcare delivered to Australian children: CareTrack Kids

    Braithwaite, J., Jaffe, A., White, L., Cowell, C. & Harris, M.

    1/11/1430/11/17

    Project: Research

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