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Exploring gaps and opportunities in primary care following an asthma hospital admission: a multisite mixed-methods study of three data sources
  1. Renee Jones1,2,
  2. Harriet Hiscock1,3,4,
  3. Shivanthan Shanthikumar4,5,6,
  4. Shaoke Lei1,3,
  5. Lena Sanci7,
  6. Katherine Chen1,4,8
  1. 1Health Services and Economics, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  2. 2Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
  3. 3Health Services Research Unit, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  4. 4Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
  5. 5Respiratory and Sleep Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  6. 6Respiratory Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  7. 7General Practice, University of Melbourne, Melbourne, Victoria, Australia
  8. 8General Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Dr Katherine Chen, Health Services Group, Murdoch Children's Research Institute, Parkville, VC 3052, Australia; katherine.chen{at}rch.org.au

Abstract

Objective Explore gaps and opportunities in primary care for children following a hospital admission for asthma.

Design Exploratory mixed-methods, using linked hospital and primary care administration data.

Setting Eligible children, aged 3–18 years, admitted to one of three hospitals in Victoria, Australia between 2017 and 2018 with a clinical diagnosis of asthma.

Results 767 caregivers of eligible children participated, 39 caregivers completed a semistructured interview and 277 general practitioners (GPs) caring for 360 children completed a survey. Over 90% (n=706) of caregivers reported their child had a regular GP. However, few (14.1%, n=108) attended a GP in the 24 hours prior to index admission or in the 7 days after (35.8%, n=275). Children readmitted for asthma (34.2%, n=263), compared with those not readmitted (65.8%, n=504), were less likely to have visited a GP in the non-acute phase of their asthma in the 12 months after index admission (22.1% vs 42.1%, respectively), and their GP was more likely to report not knowing the child had an asthma admission (52.8% vs 39.2%, respectively). Fewer GPs reported being extremely confident managing children with poorly controlled asthma (11.9%, n=43) or post-discharge (16.7%, n=60), compared with children with well-controlled asthma (36.4%, n=131), with no difference by child readmission status.

Conclusions Given the exploratory design and descriptive approach, it is unknown if the differences by child readmission status have any causal relationship with readmission. Nonetheless, improving preventative patterns of primary care visits, timely communication between hospitals and primary care providers, and guideline concordant care by GPs are needed.

  • qualitative research
  • primary health care
  • child health services
  • child health
  • respiratory medicine

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Footnotes

  • Contributors KC and HH conceived the presented study. RJ, HH and KC developed the study methods. SL and SS provided feedback on these methods. RJ collected study data with supervision from HH and KC. RJ and SL completed the data analysis. RJ, KC, HH, SL, SS and LS reviewed and provided input into the interpretation of results. RJ drafted the manuscript with input from KC, HH, SL, SS and LS. KC is responsible for the overall content as guarantor.

  • Funding This study was funded by the Melbourne Academic Centre for Health (MACH). HH is supported by NHMRC Practitioner Fellowship Award (1136222). The Victorian Government’s Operational Infrastructure Support Program to support research at the Murdoch Children’s Research Institute. KC is supported by MACH’s Clinician Scientist Fellowship, the Royal Children’s Hospital Foundation and Murdoch Children’s Research Institute Clinician Scientist Fellowship. SS is supported by a Murdoch Children’s Research Institute Clinician Scientist Fellowship.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.