G357(P) Reducing emergency care attendance in asthma: Which children do we need to focus on?

Abstract

AimsAsthma is the commonest chronic condition of childhood with 1 in 11 UK children currently on treatment.1 When properly maintained the asthmatic child can usually lead a normal life, whereas poorly controlled asthma can lead to reduced quality of life, morbidity and mortality, resulting in 25,073 UK paediatric hospital admissions in 2011–12.2 Guidelines facilitating management, aimed at reducing these complications are frequently updated but are not immune to lack of adherence and compliance. In this audit, we focussed on community data which can assist targeting patients at high risk of complications.MethodsWe reviewed all 126 paediatric asthma cases at an urban GP practice. We recorded the percentage of prescribed corticosteroid inhalers collected as a measure of inadherence, number of overdue months of annual review as a measure of noncompliance, and emergency care attendances for asthma as a measure of complication risk, between 01/01/2014–01/01/2015.Abstract G357(P) Figure 1Variation in adherence, compliance and complications with delay in annual reviewAbstract G357(P) Figure 2ResultsThere was no significant difference in adherence for children who attended routine review up to 5 months from due time compared to those attending six to eleven months overdue (74% vs 68%). The latter group was significantly more likely to require emergency care (OD=4, CI=1.29–12.40, p < 0.025) but was also at significantly higher risk to require emergency care than children who attended review over 12 months overdue (OD = 4.33, CI=1.40–13.42, p < 0.025), despite higher rate of inhaler collection (68% vs 50%, OD=4 (CI=1.4–13.4, p < 0.025).ConclusionDespite a high and similar compliance rate, children with low annual review adherence are at significantly higher risk for complications. These results reinforce the usefulness of current guidelines and the importance of annual review for patient education and medication titration. Interestingly the subgroup with the lowest compliance and adherence was not at increased complication risk. This may be due to imprecise diagnosis, milder disease, or overmedication; future investigation of this group can assist in correct resource allocation.Finally our results suggest the importance of targeting those who require treatment (as expressed by inhalers uptake), yet substantially delay the annual review.References accessed 02/15/15 accessed 02/12/15