Asthma

Hospital asthma management not on the same page as guidelines


Respiratory specialists are recommending health services check their adherence to asthma guideline recommendations after finding their own Victorian network offered suboptimal post-acute care for patients presenting with asthma attacks.

A retrospective study of 1,273 patients with acute asthma treated at The Alfred and Sandringham hospitals between 2015 and 2020 showed patients often missed out on guideline-based care, with inhaler technique assessment, action plan provision and organisation of specialist follow-up only given 56%, 34% and 44% of the time.

“Regrettably, the rate of documented asthma action plans was no different from a previously reported rate of 33% in a South Australian population survey in 1996,” Alfred Hospital physician in training Dr Joanna Huang and her team wrote in the Internal Medicine Journal.

The deficiency in action plans was most notable in patients over 60, who also had higher rates of asthma-related re-presentation within 90 days.

Meanwhile, nearly a quarter of patients missed out on corticosteroids but almost all patients (99.4%) received a beta-2-agonist in hospital.

Patients who received appropriate care were more likely to have had respiratory specialist input than those who didn’t, yet only 36% actually had specialist involvement.

Those treated by junior doctors in emergency departments were more frequently referred to respiratory outpatient services and given letters to GPs than those with more senior doctors — possibly reflecting extra time pressures and supervision responsibilities on the latter, the authors suggested.

“There is a need to improve appropriate asthma post-acute care at the point of care for those discharged directly from emergency in order to improve quality of life and mortality, and reduce healthcare utilisation,” the study authors wrote.

Achieving this may require “the development of systems embedded in the electronic medical record to enhance guideline concordance”, automated processes to capture all acute asthma cases and additional staff resources to increase specialist input in hospital and during follow-up.

“National asthma guidelines for the optimisation and standardisation of care are readily available and detailed in the Australian Asthma Handbook,” the authors added.

Given their findings, the authors said “each health service should evaluate its own adherence to guideline recommendations”.

“Further work is needed to identify systemic barriers to guideline implementation and to optimise clinical practice, both within emergency departments, and more broadly across all inpatient settings,” they concluded.

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