Hospital Readmissions on the Rise for Children With Asthma in Australia

Hospital readmissions for asthma are not only increasing among children, children are returning to the hospital for reasons that are preventable, according to a recent study from Australia.

Asthma is the most common chronic pediatric illness in first-world countries, affecting about 10% of children.

The study, published in the Journal of Asthma, found about 1 in 3 children returned to the hospital for asthma, compared with 1 in 5 a decade ago.

The study involved 767 children, aged 3 to 18 years, who were admitted to 3 hospitals in Victoria between 2017-2018 with a diagnosis of asthma. Researchers used linked administrative databases, electronic medical records, and national pharmaceutical data. In addition, caregivers and 277 general practitioners (GPs) completed surveys regarding the home environment and the clinicians’ usual asthma management practices, respectively.

The clinican survey asked about the GP's pediatric experience and training, confidence with caring for children with asthma, and usual asthma management. They were also asked to read a case of a patient with persistent asthma symptoms and choose multiple care options, as per the National Asthma Council Australia guidelines.

Factors that could possibly alter the chances of hospital readmission included:

• The use of asthma action plans (AAP)
• Documented reviews of both inhaler technique as well as asthma education
• A follow-up visit booked at the hospital before discharge
• Review of allergy management
• Discharged with asthma medications
• Prescription of controller medications, such as inhaled corticosteroids or leukotriene antagonists

The primary outcome was readmission with asthma within 12 months; secondary outcomes included returning to the emergency department (ED) for asthma and rescue oral corticosteroid use.

Of the 767 patients, children, 34.3% were readmitted to hospital for asthma, and the majority of those were aged 3 to 5 years, accounting for 69.2% of the readmissions.

Children aged 6–11  years made up the next largest group to be readmitted, followed by adolescents aged 12–18  years.

Out of the total number of children, 20.6% were readmitted once and 13.7% had 2 or more readmissions in 12 months. Only 7.6% of the group returned to the ED without needing to be admitted.

While none of the factors associated with hospital or home environments were linked with hospital readmissions, the effect of clinicians reporting care not aligned with clinical guidelines raised the liklihood of readmission (OR, 1.57; 95% CI, 1.00–2.47; P = .05).

While most physicians reported that they provide AAPs and were aware of guidelines, "over 40% of GPs reported guideline-discordant care for questions about children with persistent asthma," the authors wrote.

Over a third of children hadn’t had a review of their inhaler technique and only about a quarter were prescribed a preventative medication or were told to continue using it, according to Katherine Chen, PhD, of the Murdoch Children’s Research Institute.

In addition, she said, almost 75% of patients were discharged from the hospital without a controller medication and more than 80% did not have a follow-up visit with a specialist booked.

Reference

Chen KYH, Chu W, Jones R, et al. Modifiable factors associated with pediatric asthma readmissions: a multi-centre linked cohort study. J Asthma. Published online June 24, 2022. doi:10.1080/02770903.2022.2089996