Laird Pamela J, Chang Anne B, Walker Roz, Barwick Melanie, Whitby Jack, Cooper Matthew N, Gill Fenella, McKinnon Elizabeth, Schultz André
Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia.
Department of Physiotherapy, Perth Children's Hospital, Perth, WA, Australia.
Lancet Reg Health West Pac. 2023 Feb 10;34:100708. doi: 10.1016/j.lanwpc.2023.100708. eCollection 2023 May.
Aboriginal children hospitalised with acute lower respiratory infections (ALRIs) are at-risk of developing bronchiectasis, which can progress from untreated protracted bacterial bronchitis, often evidenced by a chronic (>4 weeks) wet cough following discharge. We aimed to facilitate follow-up for Aboriginal children hospitalised with ALRIs to provide optimal management and improve their respiratory health outcomes.
We implemented an intervention to facilitate medical follow-up four weeks after hospital discharge from a paediatric hospital in Western Australia. The intervention included six-core components that focused on parents, hospital staff and hospital processes. Both health and implementation outcomes were measured for children grouped by three distinct temporal periods of recruitment: (i) nil-intervention, recruited after hospital admission; (ii) health-information only, received during recruitment at hospital admission, pre-intervention; (iii) post-intervention. The primary outcome was the cough-specific quality-of-life score (PC-QoL) in children with a chronic wet cough following discharge.
Of the 214 patients that were recruited, 181 completed the study. Follow-up rates one-month post-discharge were higher in the post-intervention (50.7%) than the nil-intervention (13.6%) and health-information (17.1%) groups. PC-QoL in children with a chronic wet cough was also improved in the post-intervention group compared the health information and nil-intervention groups (difference in means between nil-intervention and post-intervention groups = 1.83, 95% CI: 0.75, 2.92, p = 0.002), aligning with an increase in the percentage who received evidence-based treatment, namely antibiotics at one-month post-discharge (57.9% versus 13.3%).
Implementation of our co-designed intervention to facilitate effective and timely medical follow-up for Aboriginal children hospitalised with ALRIs improved their respiratory health outcomes.
State, national grants and fellowships.
因急性下呼吸道感染（ALRIs）住院的原住民儿童有患支气管扩张的风险，支气管扩张可能由未经治疗的迁延性细菌性支气管炎发展而来，通常表现为出院后持续（超过4周）的湿性咳嗽。我们旨在为因ALRIs住院的原住民儿童提供随访便利，以实现最佳管理并改善他们的呼吸健康状况。
我们实施了一项干预措施，以促进西澳大利亚一家儿科医院出院四周后的医疗随访。该干预措施包括六个核心组成部分，重点针对家长、医院工作人员和医院流程。对按三个不同招募时间段分组的儿童进行健康和实施效果评估：（i）无干预组，入院后招募；（ii）仅提供健康信息组，在入院招募时、干预前接受；（iii）干预后组。主要结局是出院后患有慢性湿性咳嗽儿童的咳嗽特异性生活质量评分（PC-QoL）。
在招募的214名患者中，181名完成了研究。出院后一个月的随访率，干预后组（50.7%）高于无干预组（13.6%）和健康信息组（17.1%）。与健康信息组和无干预组相比，干预后组中患有慢性湿性咳嗽儿童的PC-QoL也有所改善（无干预组与干预后组之间的均值差异 = 1.83，95% CI：0.75，2.92，p = 0.002），这与出院后一个月接受循证治疗（即抗生素治疗）的百分比增加相一致（57.9% 对 13.3%）。
实施我们共同设计的干预措施，以促进对因ALRIs住院的原住民儿童进行有效及时的医疗随访，改善了他们的呼吸健康状况。
州、国家拨款和奖学金。
