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Appropriate management of acute gastroenteritis in Australian children: A population-based study
Neroli Sunderland1, Johanna Westbrook1, Rachel Urwin1
1Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
Insights
Australian children with acute gastroenteritis (AGE) receive guideline-consistent care 45.5% of the time, with significant variation between diagnosis, treatment, and management phases. Treatment adherence is high, but diagnosis and management adherence are lower, especially in general practice settings.
Area of Science:
- Pediatrics
- Public Health
- Health Services Research
Background:
- Acute gastroenteritis (AGE) is a common childhood illness.
- Clinical practice guidelines (CPGs) exist to standardize care for AGE.
- Adherence to CPGs in pediatric care settings requires evaluation.
Purpose of the Study:
- To assess the proportion of care for children with AGE in Australia that aligns with established clinical practice guidelines.
- To identify variations in guideline adherence across different healthcare settings and phases of care.
Main Methods:
- Developed and validated indicators from national and international CPGs for AGE.
- Reviewed medical records of children (≤15 years) with AGE across General Practitioner (GP), Emergency Department (ED), and inpatient settings in Australia.
- Trained paediatric nurses audited 35 indicators to determine adherence during diagnosis, treatment, and ongoing management.
Main Results:
- A total of 14,434 indicator assessments were conducted across 854 healthcare visits.
- Overall guideline adherence was 45.5% for diagnosis, 96.1% for treatment, and 57.6% for ongoing management.
- Adherence was significantly higher in ED (84.7%) and inpatient (84.3%) settings compared to GP settings (54.6%), driven by diagnosis and management phases.
Conclusions:
- Adherence to clinical guidelines for pediatric AGE care in Australia varies by care phase and healthcare setting.
- While treatment adherence is high (>90%), diagnostic and ongoing management procedures are less consistently documented and followed, particularly in general practice.
- Improving documentation and adherence in diagnosis and management phases is crucial, especially in primary care settings.
Objectives:
To determine the proportion of care provided to children with acute gastroenteritis (AGE) in Australia consistent with clinical practice guidelines.
Methods:
Indicators were developed from national and international clinical practice guideline (CPG) recommendations and validated by an expert panel. Medical records from children ≤15 years presenting with AGE in three healthcare settings-Emergency Department (ED), hospital admissions and General Practitioner (GP) consultations-from randomly selected health districts across three Australian States were reviewed. Records were audited against 35 indicators by trained paediatric nurses, to determine adherence to CPGs during diagnosis, treatment, and ongoing management.
Results:
A total of 14,434 indicator assessments were performed from 854 healthcare visits for AGE by 669 children, across 75 GPs, 34 EDs and 26 hospital inpatient services. Documented adherence to guidelines across all healthcare settings was 45.5% for indicators relating to diagnosis (95% CI: 40.7-50.4), 96.1% for treatment (95% CI: 94.8-97.1) and 57.6% for ongoing management (95% CI: 51.3-63.7). Adherence varied by healthcare setting, with adherence in GPs (54.6%; 95% CI: 51.1-58.1) lower than for either ED settings (84.7%; 95% CI: 82.4-86.9) or for inpatients (84.3%; 95% CI: 80.0-87.9); p<0.0001 for both differences. The difference between settings was driven by differences in the diagnosis and ongoing management phases of care.
Conclusions:
Adherence to clinical guidelines for children presenting to healthcare providers with AGE varies according to phase of care and healthcare setting. Although appropriate diagnostic assessment and ongoing management phase procedures are not well documented in medical records (particularly in the GP setting), in the treatment phase children are treated in accordance with guidelines over 90% of the time.
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