Message in a bottle: How evidence‐based medicine and a programme change model improved asthma management in a low‐income emergency department in Papua New Guinea

Abstract

Objective To improve asthma care in a complex, low resource, developing country setting. This observational study was carried out in a challenging low‐income real‐life setting in the ED at Modilon Hospital, Papua New Guinea. The only government hospital in Madang Province, with 258 beds, it provides medical care to a population of nearly 700 000 people of whom 40% live on less than US$1.25/day. Methods An asthma management analysis questionnaire followed by action research, with a four‐step programme change model (exposure, adoption, implementation and practice), were used to develop and implement new department asthma guidelines. Staff perceptions were gathered via discussion groups and questionnaire. Results Asthma management initially involved frequent antibiotics, intravenous steroids, multiple short acting bronchodilators (oral, inhaled and nebulised) and limited oral steroids. No spacers, preventative inhaled steroid therapy or asthma action plans were used. On review after new guideline implementation staff felt antibiotic dispensing and concurrent use of multiple short acting oral bronchodilators decreased and spacer, preventer therapy and action plan use increased. Conclusion This project highlights the difficulties experienced with change management, both in general and in a limited resource setting. Lack of data limits conclusions about asthma management improvement. However, positive trends were apparent and make this approach reasonable for those considering change management strategies in a similar setting.

World Health Assembly Resolution 72.16: What are the implications for the Australasian College for Emergency Medicine and emergency care development in the Indo‐Pacific?

“…Publications from the region provide insights into EC needs and demonstrate how effective interventions can be developed and implemented at low cost. In Fiji, trauma management has been improved through enhanced surveillance and team‐based care; in Papua New Guinea, action research has helped optimise asthma treatment; and in the Solomon Islands, inconsistent triage (a challenge in many Pacific Island countries) has been addressed by a simple, locally developed triage system . Despite experiencing significant disasters, Indonesia and Myanmar have only recently developed specialty training in emergency medicine (EM) and have identified that the crucial pre‐hospital EC needs can be assisted by simple rural systems and basic protocols …”

Emergency care status, priorities and standards for the Pacific region: A multiphase survey and consensus process across 17 different Pacific Island Countries and Territories

“…Most EC stakeholders reported using a standardised resuscitation guideline at their national hospital, but agreed that further guideline development with widespread and consistent implementation was a priority. Examples of evidence-based, context appropriate clinical guidelines to improve EC exist for trauma care in Fiji [40] and acute asthma in PNG, [41] as well as a framework for developing and sharing locally adapted clinical EC guidelines. [42] The need for pre-hospital clinical practice guidelines is highlighted in Timor-Leste, [43] as one component of many essential Process priorities and standards required to build an effective prehospital system.…”

Rising to the challenge: The emergency nursing response to COVID-19 in the Pacific

“…A shared challenge for Melanesian countries is asthma management. Issues include overuse of antibiotics and nebulisers, underuse of preventative therapy, and limited access to metered dose inhalers (MDIs) [ 15 ]. In many EDs, it is common for patients to visit ‘asthma stations’ within ED waiting rooms to self-administer nebulised medications.…”