Improving paediatric asthma outcomes in rural settings: clinical effectiveness of a multicomponent asthma care model

Asthma is a leading cause of childhood hospitalisation and emergency department (ED) presentations in Australia. Barriers persist in accessing paediatric asthma care, particularly in rural areas. We implemented and evaluated a multicomponent model to reduce preventable hospital presentations across rural New South Wales.

We conducted pre-post evaluation of children aged 5-12 years with asthma exacerbations across 13 hospitals in four rural NSW health districts. Children received: 1) a standardised discharge pack, 2) general practitioners (GP) and school linkage, 3) text reminders, and 4) nurse-led virtual home visits for uncontrolled asthma. Primary outcome was healthcare utilisation (ED presentations, admissions and GP visits) from electronic records, comparing matched pre-post periods at 1, 3, 6 and 12 months. Secondary outcomes included asthma control and quality of life at 6 and 12 months. Analyses used generalised estimating equations and mixed-effects models to calculate adjusted rate ratios (aRRs) and mean differences.

188 children participated (62% male, mean age 7.6 years). ED presentations decreased 93% at 1 month (aRR 0.07, 95% confidence interval 0.04-0.12), 85% at 3 months (aRR 0.15, 0.10-0.22), 78% at 6 months (aRR 0.22, 0.16-0.30) and 69% at 12 months (aRR 0.31, 0.25-0.40). Hospital admissions decreased 97%, 95%, 90% and 81%. Uncontrolled asthma decreased from 73% to 37% (6 months) and 30% (12 months). Asthma control and quality of life improved significantly at both timepoints.

This multisite study achieved sustained reductions in preventable hospitalisations and meaningful improvements in asthma control and quality of life. This model offers a replicable approach for underserved populations.