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

Research output: Contribution to journalArticleResearchpeer-review

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.

LanguageEnglish
Number of pages9
JournalRespirology
DOIs
Publication statusE-pub ahead of print - 20 Jun 2019

Fingerprint

Asthma
Pediatrics
Population
Practice Guidelines
Medical Records
Inpatients
General Practice
Hospital Emergency Service
Medical Audit
Guideline Adherence
Surveys and Questionnaires
Vital Signs
Nebulizers and Vaporizers
Patient Compliance
Referral and Consultation
Drug Therapy

Keywords

  • asthma
  • asthma management guidelines
  • paediatric asthma
  • paediatrics

Cite this

Homaira, Nusrat ; Wiles, Louise K. ; Gardner, Claire ; Molloy, Charlotte J. ; Arnolda, Gaston ; Ting, Hsuen P. ; Hibbert, Peter ; Boyling, Claire ; Braithwaite, Jeffrey ; Jaffe, Adam ; CareTrack Kids Investigative Team. / Assessing appropriateness of paediatric asthma management : a population-based sample survey. In: Respirology. 2019.
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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.",
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author = "Nusrat Homaira and Wiles, {Louise K.} and Claire Gardner and Molloy, {Charlotte J.} and Gaston Arnolda and Ting, {Hsuen P.} and Peter Hibbert and Claire Boyling and Jeffrey Braithwaite and Adam Jaffe and {CareTrack Kids Investigative Team}",
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Assessing appropriateness of paediatric asthma management : a population-based sample survey. / Homaira, Nusrat; Wiles, Louise K.; Gardner, Claire; Molloy, Charlotte J.; Arnolda, Gaston; Ting, Hsuen P.; Hibbert, Peter; Boyling, Claire; Braithwaite, Jeffrey; Jaffe, Adam; CareTrack Kids Investigative Team.

In: Respirology, 20.06.2019.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Gardner, Claire

AU - Molloy, Charlotte J.

AU - Arnolda, Gaston

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AB - 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.

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