GPs key to preventing child asthma readmissions

Children with asthma who do not regularly see their GP are more likely to be admitted to hospital, new research has found.

A broader approach to care is required to improve the treatment of children with asthma to prevent hospital readmissions, according to a paediatrician and researcher from the Murdoch Children’s Research Institute.

The new research has found only one in five children with asthma visited their regular GP on more than 60% of occasions, while only 36% saw their GP within seven days of being discharged from hospital. 

The findings are contained in two studies, published in the Journal of Asthma and Archives of Diseases in Childhood, which followed 277 GPs and 767 caregivers of children aged three to 18 years who were admitted to one of three hospitals in Victoria with asthma.

Dr Katherine Chen, a Melbourne paediatrician, led the research which found that frequent GP visits were associated with reduced emergency department presentations, lower hospital readmissions and improved asthma outcomes.

“In our study, we found that visits to GPs are inconsistent, meaning that children go only when they are unwell and they often go to see many different GPs rather than a regular GP [resulting in] poor consistency in care,” Dr Chen told InSight+.

“This irregular pattern of seeing a GP is associated with going back to the hospital.”

The research also found only 39% of GPs knew their patient had been readmitted to hospital for asthma.

This highlights the need for extra care in communicating a patient’s condition back to their local GP, Dr Chen said.

“Doctors treating the children in hospital need to share key information back to the family’s GP and their recommendations for ongoing care,” she said.

“Doctors in hospital could emphasise that proactive, regular care is very important for managing asthma.”

The research also found only 12% of GPs were confident managing children with poorly controlled asthma and 17% were confident in handling asthma after discharge.

Dr Chen said she was not surprised by these findings.

“The findings of GPs reporting lower confidence in managing children with poorly controlled asthma is similar to other studies,” she said.

“It is not surprising as GPs need to manage a wide range of conditions across the spectrum of life. Our findings highlight opportunities of collaboration between GPs and specialists in a timely manner to help support the care of children with poorly controlled asthma in the community, closer to home.”

Dr Chen said children with asthma living in regional areas or from disadvantaged backgrounds have less access to GPs, putting them at greatest risk.

“Patients living in regional areas where there are fewer GPs may find it harder to get an appointment if their child is unwell,” she said.

“This raises concerns about equity of access to primary care as some families may not be able to receive regular care or obtain an appointment during an asthma attack due to cost or GP shortages in some regions.”

The decline in the number of GP practices bulk billing may discourage caregivers from taking their child with asthma for a regular check-up.

“The increasing cost of seeing a doctor will have real implications for diseases such as asthma,” Dr Chen said.

“This will have real implications for chronic injury management, particularly for families living in more regional areas and those who are more socially vulnerable.”

A broader approach is required to ensuring children with asthma get appropriate care, which may involve more pharmacists and community nurses, Dr Chen said.

“Improving the treatment of people with asthma is all about teamwork,” she said.

“We need a broader approach to the care of children with asthma.

“The pharmacist is often the first port of call so children can get Ventolin [GSK]. The pharmacist is a good source of information and can provide care as well.

“There are also community nurses with asthma expertise who have a lot of experience in providing regular follow-up and education.”

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