A new study indicates that approximately 80% of asthma-related hospitalizations could be avoided with a standardised comprehensive care pathway for children with asthma.
The study’s findings were published in the ‘Journal of Asthma and Allergy‘. In Australia, one in every ten school-aged children has a current diagnosis of asthma. Each year, approximately 40,000 asthmatic hospitalizations occur, with more than 40% occurring in children under the age of 14.
The study discovered that the majority of these asthma-related hospitalizations could be avoided with a standardised comprehensive asthma care pathway for children.
These preventative measures include the application of evidence-based clinical guidelines, the establishment of an asthma action plan, regular follow-up with a primary care physician, the provision of asthma education to parents/caregivers, and the establishment of a community-based approach to care continuity.
“We surveyed 236 nurses and 266 doctors across 37 hospitals in all 15 local health districts (LHDs) in New South Wales (NSW) to ascertain the current care pathway for children with asthma following hospital discharge,” said Dr Nusrat Homaira, the study’s senior author and a respiratory epidemiologist at UNSW Sydney.
The researchers at UNSW Sydney identified several significant variations in the existing asthma care pathway, including the following:
Although clinical guidelines and asthma action plans were used across all hospitals, on average, four to six different types of documents were used within each (LHD), between hospitals within the same LHD, and within departments within the same hospital.
Such variations can be perplexing for physicians, nurses, and parents/caregivers, as one survey participant noted: “Conflicting advice given to asthma patients by general practitioners, emergency departments, and occasionally paediatricians; patients are then confused about what to do in the event of an exacerbation of symptoms.”
Follow-up with GP: In the majority of LHDs (75 percent), parents/caregivers were advised to schedule a follow-up appointment with their child’s GP within two to three days of hospital discharge, but in some rural and regional areas, follow-up appointments could be recommended up to six days after hospital discharge. According to reports, parents/caregivers were responsible for scheduling follow-up visits with their GP and there was no system in place to ensure they attended.
Formal asthma education (27 percent of respondents) was rarely provided to parents/caregivers of children with asthma during hospital stays; it was limited to asthma device techniques and rarely included key topics such as basic knowledge of asthma, asthma control, and the importance of routine medical review.
Communication with schools/childcare services: Only 4% of surveyed staff reported that schools or childcare services were notified of a child’s recent hospital presentation.
Integration with community services: The majority of participants (55%) were unaware of any community services available to children with asthma in their local areas (for example, post-discharge asthma assessment, home visits, community asthma education, etc.).
The researchers discovered significant variations in asthma care and management for children across NSW’s health districts, hospitals within the same district, and departments within the same hospital.
This article is significant because it identifies opportunities to improve health outcomes for children with asthma and to alleviate the unnecessary burden on the health system caused by avoidable asthma hospital presentations.
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