Assessing appropriateness of paediatric asthma management: A population‐based sample survey

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.

Identifying the asthma research priorities of people with asthma, their carers and other stakeholders

“…Care fragmentation and inequity is widespread and has been associated with poor health outcomes 24,25 . End‐users expressed a common desire for researching effective training and educational strategies for improving asthma knowledge among clinicians.…”

“…Care fragmentation and inequity is widespread and has been associated with poor health outcomes. 24,25 End-users F I G U R E 3 Theme frequency by end-users. (A) response to question 1: 'what you would like to see answered by research to improve living with asthma on a day-to-day basis?'…”

“…9,35 Many themes and questions prioritized by end-users also reflect priorities of current and recent past asthma researchers in Australia and internationally. These include asthma remission, [17][18][19] COVID 19 and asthma, 20 asthma care and self-management 24,25 and asthma diagnosis 30 which provides reassurance that the agenda and priorities are valid.…”

Beliefs and Factors Affecting the Usage and Compliance of Inhalers in Treatment of Asthma in Children

“…In order to improve asthma control among the paediatric age group, a personalized guidance for managing the symptoms, through a written action plan is essential [20].Studies have shown that having a written asthma treatment plan can significantly reduce the number of ER visits due to asthma attacks [21].…”

Suboptimal asthma care: Lessons from Australia and a way forward

“…In a recent publication in Respirology , Homaira et al . present the detailed guideline adherence in paediatric asthma from the CareTrack Kids study . A total of 39 indicators of quality asthma care were developed from three major asthma clinical practice guidelines.…”