Assessing appropriateness of paediatric asthma management: A population-based sample survey
Nusrat Homaira1,2, Louise K Wiles3, Claire Gardner3
1Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia.
Insights
Australian paediatric asthma care shows significant gaps in guideline adherence, with only 58.1% overall compliance. Key areas for improvement include vital sign recording and medication review for children with asthma.
Area of Science:
- Pediatric Pulmonology
- Health Services Research
- Clinical Quality Improvement
Background:
- Paediatric asthma care in Australia was assessed for adherence to clinical practice guidelines (CPG).
- National and international guidelines were reviewed to develop audit indicators.
Purpose of the Study:
- To comprehensively assess guideline adherence in paediatric asthma care across various Australian healthcare settings.
- To identify variations in care quality and areas for improvement.
Main Methods:
- A retrospective medical record review was conducted for children aged ≤15 years across inpatient, emergency department, general practice, and paediatrician consultations.
- 39 audit indicators were assessed by trained paediatric nurses across 1600 visits in 129 locations.
Main Results:
- Overall adherence to asthma care guidelines was 58.1%.
- Adherence varied by setting: 54.4% in general practice, 77.7% by paediatricians, 79.9% in emergency departments, and 85.1% for inpatient care.
- Lowest adherence rates were observed for recording vital signs (15.1%) and reviewing medication compliance, inhaler technique, and triggers (20.5%).
Conclusions:
- Significant discrepancies exist between current paediatric asthma care practices and CPG recommendations in Australia.
- Implementing evidence-based interventions is crucial to standardize care quality and reduce practice variations.
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.
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