Improving paediatric asthma outcomes in rural settings: clinical effectiveness of a multicomponent asthma care model.

Abstract

Introduction: Asthma is a leading cause of childhood hospitalisation and emergency department (ED) presentations in Australia. Barriers persist in accessing paediatric asthma care, particularly in rural areas. We implemented and evaluated a multicomponent model to reduce preventable hospital presentations across rural New South Wales.

Methods: We conducted pre-post evaluation of children aged 5-12 years with asthma exacerbations across 13 hospitals in four rural NSW health districts. Children received: 1) a standardised discharge pack, 2) general practitioners (GP) and school linkage, 3) text reminders, and 4) nurse-led virtual home visits for uncontrolled asthma. Primary outcome was healthcare utilisation (ED presentations, admissions and GP visits) from electronic records, comparing matched pre-post periods at 1, 3, 6 and 12 months. Secondary outcomes included asthma control and quality of life at 6 and 12 months. Analyses used generalised estimating equations and mixed-effects models to calculate adjusted rate ratios (aRRs) and mean differences.

Results: 188 children participated (62% male, mean age 7.6 years). ED presentations decreased 93% at 1 month (aRR 0.07, 95% confidence interval 0.04-0.12), 85% at 3 months (aRR 0.15, 0.10-0.22), 78% at 6 months (aRR 0.22, 0.16-0.30) and 69% at 12 months (aRR 0.31, 0.25-0.40). Hospital admissions decreased 97%, 95%, 90% and 81%. Uncontrolled asthma decreased from 73% to 37% (6 months) and 30% (12 months). Asthma control and quality of life improved significantly at both timepoints.

Conclusion: This multisite study achieved sustained reductions in preventable hospitalisations and meaningful improvements in asthma control and quality of life. This model offers a replicable approach for underserved populations.