Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia.
Respiratory Department, Sydney Children's Hospital, Sydney, NSW, Australia.
Respirology. 2020 Jan;25(1):71-79. doi: 10.1111/resp.13611. Epub 2019 Jun 20.
We conducted a comprehensive assessment of guideline adherence in paediatric asthma care, including inpatient and ambulatory services, in Australia.
National and international clinical practice guidelines (CPG) relating to asthma in children were searched and 39 medical record audit indicator questions were developed. Retrospective medical record review was conducted across hospital inpatient admissions, emergency department (ED) presentations, general practice (GP) and paediatrician consultations in three Australian states for children aged ≤15 years receiving care in 2012 and 2013. Eligibility of, and adherence to, indicators was assessed from medical records by nine experienced and purpose-trained paediatric nurses (surveyors).
Surveyors conducted 18 453 asthma indicator assessments across 1600 visits for 881 children in 129 locations. Overall, the adherence for asthma care across the 39 indicators was 58.1%, with 54.4% adherence at GP (95% CI: 46.0-62.5), 77.7% by paediatricians (95% CI: 40.5-97.0), 79.9% in ED (95% CI: 70.6-87.3) and 85.1% for inpatient care (95% CI: 76.7-91.5). For 14 acute asthma indicators, overall adherence was 56.3% (95% CI: 47.6-64.7). Lowest adherences were for recording all four types of vital signs in children aged >2 years presenting with asthma attack (15.1%, 95% CI: 8.7-23.7), and reviewing patients' compliance, inhaler technique and triggers prior to commencing a new drug therapy (20.5%, 95% CI: 10.1-34.8).
The study demonstrated differences between existing care and CPG recommendations for paediatric asthma care in Australia. Evidence-based interventions to improve adherence to CPG may help to standardize quality of paediatric asthma care and reduce variation of care.
我们对澳大利亚儿科哮喘护理中的住院和门诊服务的指南遵循情况进行了全面评估，包括住院和门诊服务。
搜索了与儿童哮喘相关的国家和国际临床实践指南（CPG），并制定了 39 个病历审核指标问题。在澳大利亚三个州，对 2012 年和 2013 年接受护理的≤15 岁儿童的医院住院、急诊科就诊、全科医生（GP）和儿科医生就诊进行了回顾性病历审查。由 9 名经验丰富且专门培训的儿科护士（调查员）根据病历评估指标的适用性和遵循情况。
调查员对 129 个地点的 881 名儿童的 1600 次就诊进行了 18453 次哮喘指标评估。总体而言，39 项哮喘护理指标的依从率为 58.1%，其中 GP 为 54.4%（95%CI：46.0-62.5），儿科医生为 77.7%（95%CI：40.5-97.0），急诊科为 79.9%（95%CI：70.6-87.3），住院部为 85.1%（95%CI：76.7-91.5）。对于 14 项急性哮喘指标，总体依从率为 56.3%（95%CI：47.6-64.7）。依从率最低的是记录≥2 岁的哮喘发作患儿的所有 4 种生命体征（15.1%，95%CI：8.7-23.7），以及在开始新药物治疗前评估患者的依从性、吸入器技术和触发因素（20.5%，95%CI：10.1-34.8）。
该研究表明，澳大利亚儿科哮喘护理中现有的护理与 CPG 建议之间存在差异。基于证据的干预措施以提高对 CPG 的依从性可能有助于标准化儿科哮喘护理的质量并减少护理的差异。
