When a child gets admitted to hospital for their asthma it is an opportunity to make a plan for staying out of hospital. But why is the rate of readmission rising?
Asthma is the most common chronic illness in Australian children, affecting one in ten, but in most cases it is readily manageable with the right medication and follow up.
So when a child ends up in hospital with an asthma exacerbation it is an important opportunity to holistically evaluate the child’s asthma management in order to improve its control and prevent future emergency trips to the hospital
But, worryingly, the rates at which children are being readmitted to hospital with their asthma are worsening. So what is going on?
Readmissions on the increase
When we studied hospital readmission rates we found that one in three children are being readmitted to hospital for their asthma within 12 months of a previous admission. The study, the results of which are still being finalised, comprised 774 children across three Victorian hospitals who had been admitted for management of their asthma between 2017 and 2018, whose progress was then tracked for 12 months. Results were similar across all three hospitals.
What surprised us was that the statistics seem to be getting worse. Ten years ago, just one in four children were being readmitted to Australian hospitals for their asthma. This increase is a burden not only on the children and families, but also on our health system.
To understand what is driving this problem, the second phase of our research is adopting a multifaceted approach – working with families, GPs and hospitals to find out how we can prevent hospital readmissions.
Could medications be used more effectively? How can hospitals improve communication and collaboration with families and GPs in the community? Could a digital device help with symptom monitoring and using medication consistently? Could we reduce exposure to environmental allergens?
Integrating hospital and community care
So far our qualitative interviews with families and surveys of GPs have told us that there is a lack of clarity between what families have been told in hospital and what the GP understands, especially around the asthma management of pre-school children.
It suggests that if we are to reduce readmission rates, then we need to better integrate hospital and community care. Families need ongoing access to community experts, whether that is doctors, nurses or outreach workers. A child’s asthma changes over time and treatment requirements need to change accordingly.
One of the key challenges arises because families struggle to see a regular GP who has paediatric asthma expertise, which means there is less opportunity for streamlined preventative care. Access to dedicated community asthma experts like an asthma nurse, or an integrated care collaboration between GP groups and hospitals, could streamline this process.