Objectives: To improve the management of childhood asthma. Subjects & Setting: Children admitted with asthma from 1st January 2000 to 31st December 2000; and children discharged with asthma from Emergency Department (ED) of Sydney Children?s Hospital (SCH) between 16th October 2000 and 28th February 2002. Methods: There were two major studies addressing aspects of asthma management, namely the retrospective in-patient study and the prospective ED presentation study. Each of these was subdivided in two different studies to address different research questions. In the first retrospective study, a priori criteria for theoretical "time ready for discharge" (TRD) for asthmatic admissions were defined based on frequency of use of salbutamol. In the second retrospective study, we followed 361 children for 1 year from the date of their discharge, to find out whether those who received asthma education, written asthma action plan, and preventer medications at the time of discharge and whose follow?up was arranged prior to discharge, represented to the ED or were readmitted. The prospective study, which also addressed two different research questions, was a randomised-controlled trial in which parents of 310 children who had been discharged from ED with asthma, received written asthma materials only or received telephone consultation in addition to written materials. Background severity and control of asthma were assessed in baseline study from parent?s reported symptom frequency and medication uses. Outcome measures: readmission and representation to the ED, regular use of preventer medications, possession and use of written asthma action plan, and asthma symptom measures. Results: (1) 116 (27.7%) children were discharged before our theoretical TRD and only 2 child who were discharged after achieving TRD, developed symptoms which required oxygenation and more frequent doses of salbutamol. Both readmission and representation to ED within one week of discharge were uncommon. (2) 121 children represented within 1 year of their discharge, of whom 68 children were readmitted. Both receiving asthma education during admission and arranging follow-up prior to discharge were associated with a decreased likelihood of representation as well as readmission (P > 0.001). (3) In RCT, the baseline study showed that 14% of children were not receiving appropriate preventer therapy despite indications; and a further 34% had frequent symptoms despite receiving preventer therapy. 62% of the parents reported of having written asthma action plan but less than 50% of them reported using it regularly. At follow up we observed both possession and use of written asthma action plan (p = 0.002) as well as regular use of preventer medications (p = 0.001) were improved in the intervention group compared with the control group. Conclusions: Discharge on 3-hourly rather than 4-hourly doses of salbutamol appears safe and shortens length of stay by an average of 5.5 hrs. Both asthma education and follow-up at the time discharge appear to reduce readmission and representation to ED. Telephone consultation can increase the regular use of preventer medications and written asthma action plan.
| Identifer | oai:union.ndltd.org:ADTP/187857 |
| Date | January 2003 |
| Creators | Khan, Md. Sanaur Rahman, School of Women?s & Children?s Health, UNSW |
| Publisher | Awarded by:University of New South Wales. School of Women?s and Children?s Health |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Copyright Md. Sanaur Rahman Khan, http://unsworks.unsw.edu.au/copyright |
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