We won't find what we don't look for: Identifying barriers and enablers of chronic wet cough in Aboriginal children

Laird, Pamela; Walker, Roz; Lane, Mary; Chang, Anne B.; Schultz, André

doi:10.1111/resp.13642

Cited by 19 publications

(29 citation statements)

References 31 publications

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“…Our finding that PBB was the most common cause of chronic cough, comprising 37.9% of children referred to tertiary respiratory care, is very similar to studies in other tertiary respiratory centres in Australia for children referred with chronic cough (40–41%) 5,20 . In comparison, asthma, a disease that is frequently regarded cause of chronic cough in children, 1,21 was diagnosed by specialists in 15.3% of our cohort, which is similar to an Australian respiratory multicentre study on children with chronic cough ( P = 0.99) 20…”

Section: Discussionsupporting

confidence: 88%

“…Lack of documentation in the referral letters regarding the presence of cough or of cough descriptors may reflect a lack of clinician and family awareness regarding the importance of identifying a chronic wet cough. 1,18 A Delphi consensus questionnaire developed recently in Australia also reflects the importance of the quality of the referral to include cough duration and cough character as a marker of what constitutes high-quality primary care of children with chronic cough. 19 Research suggests that chronic wet cough is considered to be normal by parents and by primary care clinicians in some settings.…”

Section: Discussionmentioning

confidence: 99%

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Frequency of protracted bacterial bronchitis and management pre‐respiratory referral

Lau

Laird

Stevenson

et al. 2021

J Paediatrics Child Health

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Aim: To determine the frequency of protracted bacterial bronchitis (PBB) in children referred to tertiary care with chronic cough and describe management prior to referral. Methods: A retrospective cohort study of all new patients with a history of ≥4 weeks of cough seen at the only tertiary paediatric outpatient respiratory service in Western Australia between July 2018 and June 2019. Medical records were reviewed until a final diagnosis was documented or otherwise for a period of 18 months. Results: PBB was the most common cause and comprised 37.9% of all children referred to tertiary respiratory care with chronic cough. In children with PBB, the median cough duration at the time of first specialist review was 5.1 months (IQR 2.1-12.0 months). The most common referral source of PBB was primary practice (40.9%) and the most common working diagnosis pre-referral was asthma (15.9%). Seventy-eight percent of children with PBB had an ongoing cough at their first respiratory review, and of these, only 13.5% had been prescribed 4 weeks of antibiotics prior to their respiratory review. Asthma treatment had been prescribed for 34.0% of children with PBB. Conclusion: PBB is the most common cause of chronic cough in children referred to tertiary respiratory care and is frequently misdiagnosed and undertreated pre-referral. There is a need to facilitate diagnosis and optimal management of PBB in primary care, which could result in earlier symptom resolution and potentially limit disease progression to bronchiectasis.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Frequency of protracted bacterial bronchitis and management pre‐respiratory referral

Lau

Laird

Stevenson

et al. 2021

J Paediatrics Child Health

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“…Children with chronic wet cough at any point in the study were referred to the local medical clinic to be treated by local doctors. Prior to this study, we also provided specific training to local clinicians on the management of chronic wet cough according to best practice guidelines [23] using strategies to address enablers and barriers for health practitioners [24].…”

Section: Methodsmentioning

confidence: 99%

Prevalence of chronic wet cough and protracted bacterial bronchitis in Aboriginal children

et al. 2019

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BackgroundChronic wet cough, the most common symptom of a disease spectrum that encompasses protracted bacterial bronchitis (PBB) and bronchiectasis, is common among Aboriginal children. In the absence of any community prevalence data, and with the high burden of respiratory disease and the European Respiratory Society task force's recommendation to identify disease burden, we determined the prevalence of chronic wet cough and PBB in young Aboriginal children in four remote communities in north Western Australia.MethodsA whole-population, prospective study was conducted. Aboriginal children aged ≤7 years were clinically assessed for chronic wet cough by paediatric respiratory clinicians between July 2018 and May 2019. Where children had a wet cough but parents reported a short or uncertain cough duration, children were followed up 1 month later. A medical record audit 6 weeks to 3 months later was used to determine those children with chronic wet cough who had PBB (based on response to antibiotics).ResultsOf the 203 children, 191 (94%; median age 3.5 years, range 0–7 years) were enrolled. At the initial visit, chronic wet cough was present in 21 (11%), absent in 143 (75%) and unknown in 27 (14%). By follow-up, the total prevalence of chronic wet cough was 13% (95% CI 8–19%) and 10% (95% CI 7–17%) for PBB. Chronic wet cough was more common in the two communities with unsealed roads (19%) compared to the two with sealed roads (7%).ConclusionGiven the relatively high prevalence, strategies to address reasons for and treatment of chronic wet cough and PBB in young Aboriginal children in remote north Western Australia are required.

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“…Many hospital staff cited time pressure as a barrier to providing culturally appropriate health information to parents, and follow-up instructions to the primary care provider. While time pressures have been cited as a barrier to providing health information in previous research [30] , when considering how lack of follow-up places patients at risk, the provision of basic information to parents and primary care providers is essential to improve health outcomes. Indeed, previous research has confirmed improved health outcomes when clinicians provide culturally secure health information [9] .…”

Section: Discussionmentioning

confidence: 99%

Respiratory follow-up to improve outcomes for Aboriginal children: twelve key steps

Laird

Walker

Gill

et al. 2021

The Lancet Regional Health - Western Pacific

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Background Among Aboriginal children, the burden of acute respiratory tract infections (ALRIs) with consequent bronchiectasis post-hospitalisation is high. Clinical practice guidelines recommend medical follow-up one-month following discharge, which provides an opportunity to screen and manage persistent symptoms and may prevent bronchiectasis. Medical follow-up is not routinely undertaken in most centres. We aimed to identify barriers and facilitators and map steps required for medical follow-up of Aboriginal children hospitalised with ALRIs. Methods Our qualitative study used a knowledge translation and participatory action research approach, with semi-structured interviews and focus groups, followed by reflexive thematic grouping and process mapping. Findings Eighteen parents of Aboriginal children hospitalised with ALRI and 144 Australian paediatric hospital staff participated. Barriers for parents were lack of information about their child's condition and need for medical follow-up. Facilitators for parents included doctors providing disease specific health information and follow-up instructions. Staff barriers included being unaware of the need for follow-up, skills in culturally responsive care and electronic discharge system limitations. Facilitators included training for clinicians in arranging follow-up and culturally secure engagement, with culturally responsive tools and improved discharge processes. Twelve-steps were identified to ensure medical follow-up. Interpretation We identified barriers and enablers for arranging effective medical follow-up for Aboriginal children hospitalised with ALRIs, summarised into four-themes, and mapped the steps required. Arranging effective follow-up is a complex process involving parents, hospital staff, hospital systems and primary healthcare services. A comprehensive knowledge translation approach may improve the follow-up process. Funding State and national grants and fellowships.

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We won't find what we don't look for: Identifying barriers and enablers of chronic wet cough in Aboriginal children

Cited by 19 publications

References 31 publications

Frequency of protracted bacterial bronchitis and management pre‐respiratory referral

Frequency of protracted bacterial bronchitis and management pre‐respiratory referral

Prevalence of chronic wet cough and protracted bacterial bronchitis in Aboriginal children

Respiratory follow-up to improve outcomes for Aboriginal children: twelve key steps

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