Understanding caregiver perspectives on challenges and solutions to pediatric asthma care for children with a previous hospital admission: a multi-site qualitative study

Abstract

Objective

Pediatric hospital admissions for asthma provide an opportunity to trigger a review of the current management with an aim of preventing readmissions. However, caregiver voices on how best to improve care are missing.

Methods

As part of a larger, mixed methods cohort study, we identified caregivers of children aged 3–18 years who had an index hospital admission to a tertiary pediatric, mixed adult and pediatric, or regional hospital in Victoria, Australia, between 1st September 2017 and 31st August 2018 with a discharge diagnosis of “Asthma” or “Wheeze” based on International Classification of Disease-10 coding. We conducted qualitative semi-structured interviews with a purposive sample of 39 caregivers. We used content analysis to identify themes from the data.

Results

Caregivers identified both challenges associated with asthma care for children with a previous hospital admission as well as solutions to improve care and potentially reduce readmissions. Key challenges included: unclear pathways for follow up care, inconsistent advice, lack of personalized management, delays in getting a diagnosis, delays in the prescription of a preventer medication, and difficulty accessing primary care during exacerbations. Follow up with an “asthma specialist”, early access to a trial of preventer medication, personalized Written Asthma Action Plans and increased access to and quality of community-based asthma support services were identified as key solutions.

Conclusions

Caregivers have identified several potential solutions that could be implemented to improve care and possibly reduce pediatric asthma hospital readmissions. The challenge now is to co-design, embed and evaluate these in healthcare systems.

Supplemental data for this article can be accessed at publisher’s website.

Keywords:

• Prevention
• pediatrics
• management/control

Acknowledgements

We would like to sincerely thank all the parents and caregivers who agreed to be interviewed for this study and took the time to share their valuable insights and experience with us. We also thank the teams from The Royal Children’s Hospital, The Northern Hospital and The Geelong Hospital for their assistance with recruitment and the expertise and insights they provided.

Declaration of interest

The authors report no conflict of interest.

Additional information

Funding

This study was funded by The Melbourne Academic Center for Health (MACH). Harriet Hiscock 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. Katherine Chen is supported by MACH’s Clinician Scientist Fellowship and the Royal Children’s Hospital Foundation and Murdoch Children’s Research Institute Clinician Scientist Fellowship.