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Child asthma hospital readmissions reach decade high


Morgan Liotta


12/07/2022 3:35:47 PM

The figures provide a ‘standout example’ of why targeted management plans in general practice are vital to avoid admissions.

GP showing child puffer
More than a third of children involved in the research had not had their inhaler technique reviewed by a GP.

Since the start of the pandemic, a lot of focus has been placed on stopping Australia’s health system from being overwhelmed by rising COVID cases.
 
But pre-COVID data recently released by paediatric researchers from the Murdoch Children’s Research Institute (MCRI) has revealed another increasing contributor to hospitalisations, albeit on a smaller scale.
 
The MCRI study suggests that around one in three Australian children hospitalised for asthma are subsequently being readmitted within the space of a year for the same condition, a rate that has increased markedly from one in five 10 years ago.
 
The research, involving 767 children aged 3–18 years who were admitted to three hospitals across Victoria between 2017–18 with an asthma diagnosis, found that 34.3% were readmitted for asthma within 12 months.
 
Children aged 3–5-years-old appear to be particularly vulnerable, accounting for 69.2% of readmissions captured by the study.
 
As concerning as these numbers are, Dr James Best, Chair of RACGP Specific Interests Child and Young Person’s Health, holds even graver fears around what the same dataset would look like post-2018.
 
‘I suspect it will be significantly worse since COVID, when we saw a dramatic decline in respiratory infections as we were taking the measures necessary to deal with the pandemic,’ he told newsGP.
 
‘Now we’re seeing the rebound effect from that … a massive increase in respiratory infections.
 
‘It would be very interesting to see what has happened since that data [was tracked] … especially with the current stress on both hospitals and general practice.’
 
According to the research, in 2017–18 around 20% of children hospitalised with asthma were readmitted once, while 13.7% had two or more readmissions in 12 months. The authors note that none of the hospital or home environmental factors ‘appeared to be associated’ with readmissions.
 
With access to general practice somewhat compromised during the pandemic, Dr Best said this has contributed to the ‘flow-on effect’ on the overrun hospital system, with respiratory conditions a ‘standout example’.
 
‘During the pandemic anyone with any respiratory symptoms was more problematic … because things like spirometry couldn’t be done, and GPs were reluctant to examine anyone with respiratory symptoms for good reason,’ he said.
 
‘Even though viruses during that period were lower, there were quite specific factors that affected asthma itself, and management of asthma I suspect may well have deteriorated significantly through the pandemic.’
 
Asthma is the most common cause of preventable paediatric hospital admissions in Australia, with children under 15 years of age more likely to be hospitalised than those over 15.
 
MCRI study lead Dr Katherine Chen said the study findings highlight the gaps in asthma care for children, reinstating the important role of GPs in management plans.
 
‘[Our study reveals that] over a third of children hadn’t had a review of their inhaler technique and only about a quarter were prescribed a preventer or asked to continue using it,’ she said.
 
‘Almost three-quarters were discharged without a preventer medication and over 80% did not have a follow-up clinic booked at the hospital, often reserved for children with difficult-to-control asthma.
 
‘Most families therefore need to navigate their child’s asthma follow-up with their GP.’
 
While Dr Best agrees, he is concerned there is some catch up to do after the pandemic slowed access to general practice.
 
‘Access to GPs, and therefore access to asthma education for children and their families, has been quite a major problem, especially in the last few months. And it’s probably going to get worse,’ he said.
 
‘This [asthma readmissions] is one of the ways that lack of access to general practice can manifest – and paediatric asthma management is really critical.’
 
The Australian Asthma Handbook recently updated its guidelines for managing the condition in adults and children, and experts warned of the importance of up-to-date asthma plans during the pandemic to avoid hospital admissions.
 
Dr Best says GPs should be aware of the current guidelines for managing paediatric asthma and their role in educating families, as one way to help reduce the pathway to hospital.
 
‘GPs have an important education role in paediatric asthma management, through awareness of the guidelines and what we should be doing,’ he said.
 
‘If we are more aware, then our patients will be more aware. But this also stresses the underlying importance of access to general practice, which is so topical.’
 
All outcomes of the MCRI study were identified through linked administrative datasets provided by caregivers’ reports of home environment and GPs’ asthma management practices.
 
The authors conclude that linked datasets are important for ‘objectively identifying the health services burden of asthma’.
 
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Dr Ian   13/07/2022 7:39:13 AM

In other lands General Practitioners have stepped up to treat all infections once up to date with vaccines and with availability of antivirals . So there needs to more general practices that can treat many more respiratory infections though they need the space-triage tents PPE masks head shields and gowns like the hospitals emergerncy departments have plus paid leave through superannution . This winter will be tough but new urgent centres and more openings to treat people with competence are needed .