TY - JOUR
T1 - Assessing appropriateness of paediatric asthma management
T2 - A population-based sample survey
AU - on behalf of the CareTrack Kids Investigative Team
AU - Homaira, Nusrat
AU - Wiles, Louise K.
AU - Gardner, Claire
AU - Molloy, Charlotte J.
AU - Arnolda, Gaston
AU - Ting, Hsuen P.
AU - Hibbert, Peter
AU - Boyling, Claire
AU - Braithwaite, Jeffrey
AU - Jaffe, Adam
N1 - Funding Information:
We acknowledge with gratitude the fieldwork conducted by our surveying team: Florence Bascombe, Jane Bollen, Samantha King, Naomi Lamberts, Amy Lowe, AnnMarie McEvoy, Stephanie Richardson, Jane Summers and Annette Sutton; thanks also go to Stan Goldstein, Annie Lau and Nicole Mealing for their earlier contributions. We would also thank those who provided data for planning and analysis of CTK: (i) Queensland Health, the NSW Ministry of Health and South Australia Health; (ii) the Australian Paediatric Research Network; (iii) the Bettering the Evaluation and Care of Health Program, University of Sydney; and (iv) the Australian Department of Human Services.
PY - 2020/1
Y1 - 2020/1
N2 - 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.
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.
KW - asthma
KW - asthma management guidelines, paediatrics
KW - paediatric asthma
UR - http://www.scopus.com/inward/record.url?scp=85067856785&partnerID=8YFLogxK
U2 - 10.1111/resp.13611
DO - 10.1111/resp.13611
M3 - Article
C2 - 31220876
AN - SCOPUS:85067856785
SN - 1323-7799
VL - 25
SP - 71
EP - 79
JO - Respirology
JF - Respirology
IS - 1
ER -