Low adherence to clinical practice guidelines in general practice is contributing to a significant variation in care for children with asthma, an Australian study shows.
The CARETRACK KIDS study reviewed medical records for 881 children aged 0-15 years across Queensland, NSW and South Australia and compared their care to indicators of guideline adherence in community and hospital settings.
It found overall adherence was 58.1% with substantial variability across healthcare settings from a low 54.4% in GP practices to 77.7% in paediatricians’ practices, 79.9% in an ED, and 85.1% for hospital inpatients.
One indicator with particularly low adherence was documentation of the peripheral capillary oxygen saturation in children with acute asthma (22.2% overall).
“The overall estimate was largely driven by low adherence by GP (3.2%), and obscures adherence rates above 80% in the two hospital settings (P = 0.003 compared to ED, and P < 0.0001 compared to inpatient settings),” the study said.
Adherence was also low (25.3% overall) regarding review of inhaler technique in children already prescribed asthma medication. Adherence by GPs was 14.6% compared to 40.6% – 53.4% in non-GP settings.
The study also found more than half of children with asthma (52.9%) were prescribed antibiotics without another condition requiring antibiotics.
“This finding concurs with other studies suggesting that children with acute asthma are more likely to be inappropriately prescribed antibiotics that are not indicated in the management of acute asthma attacks.”
The researchers said their findings demonstrated a large deficit between the actual care provided to children with asthma and appropriate care as recommended in clinical practice guidelines.
“Low compliance with asthma management guidelines in primary care setting is linked to GP perception of the usefulness of all items in asthma management guidelines, suggesting that strategies to improve guidelines acceptance through iterative consultative process may improve adherence among GP.”