Evaluation of the implementation and clinical effects of an intervention to improve medical follow-up and health outcomes for Aboriginal children hospitalised with chest infections

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Article

关键词: PROTRACTED BACTERIAL BRONCHITIS;    INDIGENOUS CHILDREN;    MANAGEMENT;    COUGH;   

DOI  :  10.1016/j.lanwpc.2023.100708

来源: SCIE

【 摘 要 】

Background 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.Methods 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.Findings 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%).Interpretation 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. Funding State, national grants and fellowships.Copyright (c) 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).