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Lau G, Walker R, Laird P, Lewis P, Kuthubutheen J, Schultz A. Identifying barriers and facilitators for the effective diagnosis and provision of primary health care for otitis media from the perspective of carers of Aboriginal children. J Paediatr Child Health 2024. [PMID: 39032110 DOI: 10.1111/jpc.16626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/21/2024] [Accepted: 07/11/2024] [Indexed: 07/22/2024]
Abstract
AIM To identify the barriers and facilitators for timely detection and optimal management of otitis media (OM) in Aboriginal children in a primary care setting from the perspective of carers of Aboriginal children. METHODS A qualitative, Aboriginal co-designed, participatory action research study with interviews and focus groups in a large town in the Kimberley, Western Australia. The Consolidated Framework for Implementation Research informed stakeholder group identification and interview framework development. Data underwent thematic analysis using NVivo software. RESULTS Thirty-two carers of Aboriginal children participated. Key barriers identified for the detection of OM were limited information about OM provided to carers and carers feeling disempowered to express their concerns. Key facilitators identified were the provision of health information through health promotion and the use of culturally secure resources. Having a culturally secure clinical environment was identified as essential, with Aboriginal Health Workers playing a vital role in clinical care. No barriers to management of OM in primary care were reported. Facilitators included health care practitioners (HCPs) emphasising the importance of completing antibiotic course and the clinic providing necessary medications. CONCLUSIONS A culturally secure health promotion strategy with health promotion teams, campaigns and resources is needed to increase community awareness of OM signs and symptoms and facilitate appropriate health seeking. It is essential that the local Aboriginal community co-lead and co-develop these initiatives to ensure the unique wisdom and knowledge of Aboriginal people are captured. HCPs and the clinic effectively facilitate management of OM by providing medications and emphasising completion of antibiotics.
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Affiliation(s)
- Gloria Lau
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Roz Walker
- Ngangk Yira Institute for Change, Murdoch University, Perth, Western Australia, Australia
| | - Pamela Laird
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Philomena Lewis
- Broome Regional Aboriginal Medical Service, Broome, Western Australia, Australia
| | - Jafri Kuthubutheen
- Division of Surgery, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
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Chang AB, Dharmage SC, Marchant JM, McCallum GB, Morris PS, Schultz A, Toombs M, Wurzel DF, Yerkovich ST, Grimwood K. Improving the Diagnosis and Treatment of Paediatric Bronchiectasis Through Research and Translation. Arch Bronconeumol 2024; 60:364-373. [PMID: 38548577 DOI: 10.1016/j.arbres.2024.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/02/2024] [Accepted: 03/04/2024] [Indexed: 06/05/2024]
Abstract
Bronchiectasis, particularly in children, is an increasingly recognised yet neglected chronic lung disorder affecting individuals in both low-to-middle and high-income countries. It has a high disease burden and there is substantial inequity within and between settings. Furthermore, compared with other chronic lung diseases, considerably fewer resources are available for children with bronchiectasis. The need to prevent bronchiectasis and to reduce its burden also synchronously aligns with its high prevalence and economic costs to health services and society. Like many chronic lung diseases, bronchiectasis often originates early in childhood, highlighting the importance of reducing the disease burden in children. Concerted efforts are therefore needed to improve disease detection, clinical management and equity of care. Modifiable factors in the causal pathways of bronchiectasis, such as preventing severe and recurrent lower respiratory infections should be addressed, whilst also acknowledging the role played by social determinants of health. Here, we highlight the importance of early recognition/detection and optimal management of bronchiectasis in children, and outline our research, which is attempting to address important clinical knowledge gaps discussed in a recent workshop. The research is grouped under three themes focussing upon primary prevention, improving diagnosis and disease characterisation, and providing better management. Our hope is that others in multiple settings will undertake additional studies in this neglected field to further improve the lives of people with bronchiectasis. We also provide a resource list with links to help inform consumers and healthcare professionals about bronchiectasis and its recognition and management.
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gabrielle B McCallum
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Peter S Morris
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia
| | - Andre Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute and Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, WA, Australia; Department of Respiratory Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Maree Toombs
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Danielle F Wurzel
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Keith Grimwood
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Gold Coast, QLD, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
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Marchant JM, Chang AB, Kennedy E, King D, Perret JL, Schultz A, Toombs MR, Versteegh L, Dharmage SC, Dingle R, Fitzerlakey N, George J, Holland A, Rigby D, Mann J, Mazzone S, O'Brien M, O'Grady KA, Petsky HL, Pham J, Smith SM, Wurzel DF, Vertigan AE, Wark P. Cough in Children and Adults: Diagnosis, Assessment and Management (CICADA). Summary of an updated position statement on chronic cough in Australia. Med J Aust 2024; 220:35-45. [PMID: 37982357 DOI: 10.5694/mja2.52157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/18/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Cough is the most common symptom leading to medical consultation. Chronic cough results in significant health care costs, impairs quality of life, and may indicate the presence of a serious underlying condition. Here, we present a summary of an updated position statement on cough management in the clinical consultation. MAIN RECOMMENDATIONS Assessment of children and adults requires a focused history of chronic cough to identify any red flag cough pointers that may indicate an underlying disease. Further assessment with examination should include a chest x-ray and spirometry (when age > 6 years). Separate paediatric and adult diagnostic management algorithms should be followed. Management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns. First Nations adults and children should be considered a high risk group. The full statement from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia for managing chronic cough is available at https://lungfoundation.com.au/resources/cicada-full-position-statement. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT Algorithms for assessment and diagnosis of adult and paediatric chronic cough are recommended. High quality evidence supports the use of child-specific chronic cough management algorithms to improve clinical outcomes, but none exist in adults. Red flags that indicate serious underlying conditions requiring investigation or referral should be identified. Early and effective treatment of chronic wet/productive cough in children is critical. Culturally specific strategies for facilitating the management of chronic cough in First Nations populations should be adopted. If the chronic cough does not resolve or is unexplained, the patient should be referred to a respiratory specialist or cough clinic.
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Affiliation(s)
- Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
- Queensland Children's Hospital, Brisbane, QLD
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
- Queensland Children's Hospital, Brisbane, QLD
- Menzies School of Health Research, Darwin, NT
| | - Emma Kennedy
- Rural and Remote Health, Flinders University, Darwin, NT
| | | | - Jennifer L Perret
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
| | - Andre Schultz
- Wal-yan Respiratory Research Centre, Perth, WA
- Perth Children's Hospital, Perth, WA
| | | | | | - Shyamali C Dharmage
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
| | | | | | - Johnson George
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
| | - Anne Holland
- Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
- Institute for Breathing and Sleep, University of Melbourne, Melbourne, VIC
| | - Debbie Rigby
- University of Queensland, Brisbane, QLD
- Queensland University of Technology, Brisbane, QLD
| | - Jennifer Mann
- Institute for Breathing and Sleep, University of Melbourne, Melbourne, VIC
- Austin Health, Melbourne, VIC
| | | | | | - Kerry-Ann O'Grady
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
| | | | | | | | | | - Anne E Vertigan
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
- John Hunter Hospital, Newcastle, NSW
| | - Peter Wark
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
- John Hunter Hospital, Newcastle, NSW
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Knisley L, Linton J, Driedger SM, Hartling L, Sun Y, Scott SD. Examining the experiences of Indigenous families seeking health information about caring for sick or injured children: a scoping review. BMJ Open 2023; 13:e069697. [PMID: 36948561 PMCID: PMC10040012 DOI: 10.1136/bmjopen-2022-069697] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVE Mapping literature on Indigenous families' experiences seeking child health information and identifying barriers and facilitators to information access. DESIGN Scoping review. DATA SOURCES We searched Medline, EMBASE, PsycINFO, Scopus and CINAHL for peer-reviewed literature and Google Advanced for grey literature. We screened tables of contents of two Indigenous research journals not consistently indexed in online health databases and used snowball sampling to supplement searches. ELIGIBILITY CRITERIA We included full-text, English-language articles, published from 2000 to the time of the search in April 2021, based on: participants (Indigenous families), concept (experiences of families seeking health information) and context (child health). DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted: citation details, study purpose, country of study, publication type, study design, data collection method, Indigenous group, family member participants, home/healthcare setting, child health area, how health information was accessed, and information-seeking barriers and facilitators. Data were examined for patterns and trends, results and implications. RESULTS Among 19 papers (representing 16 research projects) included, nine described family/friends and 19 described healthcare professionals as sources of child health information. Barriers include racism/discrimination during healthcare visits, ineffective communication with healthcare providers and structural barriers (eg, transportation). Facilitators include easy access, improved communication and relationships with healthcare providers, and culturally safe healthcare. CONCLUSION Indigenous families perceive they do not have access to necessary child health information, which can lead to insensitive, ineffective and unsafe healthcare. A critical gap exists in understanding Indigenous families' information needs and preferences when making decisions about children's health.
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Affiliation(s)
- Lisa Knisley
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Janice Linton
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Yuting Sun
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Laird PJ, Chang AB, Walker R, Barwick M, Whitby J, Cooper MN, Gill F, McKinnon E, Schultz A. 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. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2023. [DOI: 10.1016/j.lanwpc.2023.100708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Laird PJ, Walker R, McCallum G, Toombs M, Barwick M, Morris P, Aitken R, Cooper M, Norman R, Patel B, Lau G, Chang AB, Schultz A. Change in health outcomes for First Nations children with chronic wet cough: rationale and study protocol for a multi-centre implementation science study. BMC Pulm Med 2022; 22:492. [PMID: 36581812 PMCID: PMC9798941 DOI: 10.1186/s12890-022-02219-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/02/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In children, chronic wet cough may be a sign of underlying lung disease, including protracted bacterial bronchitis (PBB) and bronchiectasis. Chronic (> 4 weeks in duration) wet cough (without indicators pointing to alternative causes) that responds to antibiotic treatment is diagnostic of PBB. Timely recognition and management of PBB can prevent disease progression to irreversible bronchiectasis with lifelong consequences. However, detection and management require timely health-seeking by carers and effective management by clinicians. We aim to improve (a) carer health-seeking for chronic wet cough in their child and (b) management of chronic wet cough in children by clinicians. We hypothesise that implementing a culturally integrated program, which is informed by barriers and facilitators identified by carers and health practitioners, will result in improved lung health of First Nations children, and in the future, a reduced the burden of bronchiectasis through the prevention of the progression of protracted bacterial bronchitis to bronchiectasis. METHODS This study is a multi-centre, pseudorandomised, stepped wedge design. The intervention is the implementation of a program. The program has two components: a knowledge dissemination component and an implementation component. The implementation is adapted to each study site using a combined Aboriginal Participatory Action Research and an Implementation Science approach, guided by the Consolidated Framework of Implementation Research. There are three categories of outcome measures related to (i) health (ii) cost, and (iii) implementation. We will measure health-seeking as the proportion of parents seeking help for their child in a 6-month period before the intervention and the same 6-month period (i.e., the same six calendar months) thereafter. The parent-proxy, Cough-specific Quality of Life (PC-QoL) will be the primary health-related outcome measure. DISCUSSION We hypothesise that a tailored intervention at each site will result in improved health-seeking for carers of children with a chronic wet cough and improved clinician management of chronic wet cough. In addition, we expect this will result in improved lung health outcomes for children with a chronic wet cough. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry; ACTRN12622000430730 , registered 16 March 2022, Retrospectively registered.
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Affiliation(s)
- Pamela J. Laird
- grid.414659.b0000 0000 8828 1230Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA Australia ,grid.410667.20000 0004 0625 8600Perth Children’s Hospital, Perth, WA Australia ,grid.1012.20000 0004 1936 7910Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Australia
| | - Roz Walker
- grid.1012.20000 0004 1936 7910School of Indigenous Studies, Poche Centre for Indigenous Health, University of Western Australia, Perth, WA Australia ,grid.1012.20000 0004 1936 7910School of Population Health, University of Western Australia, Perth, WA Australia ,grid.1025.60000 0004 0436 6763Ngangk Yira Institute for Change, Murdoch University, Perth Western, Australia
| | - Gabrielle McCallum
- grid.1043.60000 0001 2157 559XChild Health Division Menzies School of Health Research, Charles Darwin University, NT Darwin, Australia
| | - Maree Toombs
- grid.1003.20000 0000 9320 7537Faculty of Medicine, University of Queensland, Brisbane, QLD Australia
| | - Melanie Barwick
- grid.42327.300000 0004 0473 9646Hospital for Sick Children, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter Morris
- grid.1043.60000 0001 2157 559XChild Health Division Menzies School of Health Research, Charles Darwin University, NT Darwin, Australia
| | - Robyn Aitken
- grid.1043.60000 0001 2157 559XChild Health Division Menzies School of Health Research, Charles Darwin University, NT Darwin, Australia ,grid.1014.40000 0004 0367 2697College of Medicine and Public Health, Flinders University, Adelaide, SA Australia ,grid.1043.60000 0001 2157 559XCharles Darwin University College of Indigenous Future, Arts & Society, Darwin, NT Australia
| | - Matthew Cooper
- grid.414659.b0000 0000 8828 1230Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA Australia
| | - Richard Norman
- grid.1032.00000 0004 0375 4078School of Population Health, Curtin University, Perth, WA Australia
| | - Bhavini Patel
- Northern Territory Department of Health, Darwin, NT Australia
| | - Gloria Lau
- grid.414659.b0000 0000 8828 1230Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA Australia ,grid.410667.20000 0004 0625 8600Perth Children’s Hospital, Perth, WA Australia
| | - Anne B. Chang
- grid.1043.60000 0001 2157 559XChild Health Division Menzies School of Health Research, Charles Darwin University, NT Darwin, Australia ,grid.240562.7Department of Respiratory Medicine, Queensland Children’s Hospital, Brisbane, QLD Australia ,grid.1003.20000 0000 9320 7537Australian Centre For Health Services Innovation, Qld University of Technology, Brisbane, QLD Australia
| | - André Schultz
- grid.414659.b0000 0000 8828 1230Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA Australia ,grid.410667.20000 0004 0625 8600Perth Children’s Hospital, Perth, WA Australia ,grid.1012.20000 0004 1936 7910Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Australia
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Laird P, Ball N, Brahim S, Brown H, Chang AB, Cooper M, Cox D, Cox D, Crute S, Foong RE, Isaacs J, Jacky J, Lau G, McKinnon E, Scanlon A, Smith EF, Thomason S, Walker R, Schultz A, Walker R, Schultz A. Prevalence of chronic respiratory diseases in Aboriginal children: A whole population study. Pediatr Pulmonol 2022; 57:3136-3144. [PMID: 36098280 PMCID: PMC9825907 DOI: 10.1002/ppul.26148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/27/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The burden of bronchiectasis is disproportionately high in Aboriginal adults, with early mortality. Bronchiectasis precursors, that is, protracted bacterial bronchitis (PBB) and chronic suppurative lung disease (CSLD), often commence in early childhood. We previously reported a 10% prevalence of PBB in Aboriginal children aged 0 to 7 years, however there are no data on prevalence of chronic lung diseases in older children. Our study aimed to determine the prevalence of PBB, CSLD, bronchiectasis, and asthma in Aboriginal children living in four communities. METHODS A whole-population cross-sectional community co-designed study of Aboriginal children aged <18-years in four remote communities in Western Australia across two-time points, a month apart. Children were assessed by pediatric respiratory clinicians with spirometry undertaken (when possible) between March-September 2021. Children with respiratory symptoms were followed up via medical record audit from either the local medical clinic or via a respiratory specialist clinic through to March 2022 to establish a final diagnosis. FINDINGS We recruited 392 (91.6%) of those in the selected communities; median age = 8.4 years (interquartile range [IQR] 5.1-11.5). Seventy children (17.9%) had a chronic respiratory pathology or abnormal spirometry results. PBB was confirmed in 30 (7.7%), CSLD = 13 (3.3%), bronchiectasis = 5 (1.3%) and asthma = 17 (4.3%). The prevalence of chronic wet cough significantly increased with increasing age. INTERPRETATION The prevalence of PBB, CSLD and bronchiectasis is high in Aboriginal children and chronic wet cough increases with age. This study highlights the high disease burden in Aboriginal children and the urgent need for strategies to address these conditions.
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Affiliation(s)
- Pamela Laird
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Department of Physiotherapy, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Division of Paediatrics, Faculty of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Nicola Ball
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Shekira Brahim
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Henry Brown
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Anne B Chang
- Child Health Division Menzies School of Health Research, Darwin, Northern Territory, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,The Centre of Children's Health Research, Australian Centre For Health Services Innovation, Qld University of Technology, Brisbane, Queensland, Australia
| | - Matthew Cooper
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Deanne Cox
- Kimberley Aboriginal Medical Service, Broome, Western Australia, Australia
| | - Denetta Cox
- Kimberley Aboriginal Medical Service, Broome, Western Australia, Australia
| | - Samantha Crute
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Department of Physiotherapy, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Rachel E Foong
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Janella Isaacs
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - John Jacky
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Gloria Lau
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | | | - Annie Scanlon
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Broome Regional Hospital, Broome, Western Australia, Australia
| | - Elizabeth F Smith
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Sarah Thomason
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Broome Regional Hospital, Broome, Western Australia, Australia
| | - Roz Walker
- School of Indigenous Studies, Poche Centre for Indigenous Health, University of Western Australia, Perth, Western Australia, Australia.,School of Population Health, University of Western Australia, Perth, Western Australia, Australia.,Ngangk Yira Institute for Change, Murdoch University, Perth, Western Australia, Australia
| | - André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Division of Paediatrics, Faculty of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Roz Walker
- School of Indigenous Studies, Poche Centre for Indigenous Health, University of Western Australia, Perth, WA, Australia.,School of Population Health, University of Western Australia, Perth, WA, Australia.,Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
| | - André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA, 6009, Australia.,Department of Paediatrics, School of Medicine, University of WA, 35 Stirling Highway, Crawley, WA, 6009, Australia.,Respiratory and Sleep Medicine, Perth Children's Hospital, 15 Hospital Ave, Nedlands, 6009, WA, Australia
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Schultz A, Chang AB, Gill F, Walker R, Barwick M, Munns S, Cooper MN, Norman R, Laird P. Implementation of a strategy to facilitate effective medical follow-up for Australian First Nations children hospitalised with lower respiratory tract infections: study protocol. BMC Pulm Med 2022; 22:92. [PMID: 35300670 PMCID: PMC8929266 DOI: 10.1186/s12890-022-01878-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND First Nations children hospitalised with acute lower respiratory infections (ALRIs) are at increased risk of future bronchiectasis (up to 15-19%) within 24-months post-hospitalisation. An identified predictive factor is persistent wet cough a month after hospitalisation and this is likely related to protracted bacterial bronchitis which can progress to bronchiectasis, if untreated. Thus, screening for, and optimally managing, persistent wet cough one-month post-hospitalisation potentially prevents bronchiectasis in First Nations' children. Our study aims to improve the post-hospitalisation medical follow-up for First Nations children hospitalised with ALRIs and thus lead to improved respiratory health. We hypothesize that implementation of a strategy, conducted in a culturally secure manner, that is informed by barriers and facilitators identified by both parents and health care providers, will improve medical follow-up and management of First Nations children hospitalized with ALRIs. METHODS Our trial is a multi-centre, pseudo-randomized stepped wedge design where the implementation of the strategy is tailored for each study site through a combined Participatory Action Research and implementation science approach informed by the Consolidated Framework of Implementation Research. Outcome measures will consist of three categories related to (i) health, (ii) economics and (iii) implementation. The primary outcome measure will be Cough-specific Quality of Life (PC-QoL). Outcomes will be measures at each study site/cluster in three different stages i.e., (i) nil-intervention control group, (ii) health information only control group and (iii) post-intervention group. DISCUSSION If our hypothesis is correct, our study findings will translate to improved health outcomes (cough related quality of life) in children who have persistent wet cough a month after hospitalization for an ALRI. Trial registration ACTRN12622000224729, prospectively registered 8 February 2022, URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382886&isReview=true .
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Affiliation(s)
- André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
- Department of Paediatrics, School of Medicine, University of WA, Perth, Australia
| | - Anne B Chang
- Child Health Division Menzies School of Health Research, Darwin, NT, Australia
- Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
- Australian Centre For Health Services Innovation, Qld University of Technology, Brisbane, QLD, Australia
| | - Fenella Gill
- Nursing Research, Perth Children's Hospital, Perth, WA, Australia
- School of Nursing, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Roz Walker
- School of Indigenous Studies, Poche Centre for Indigenous Health, University of Western Australia, Perth, WA, Australia
- School of Population Health, University of Western Australia, Perth, WA, Australia
- Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
| | - Melanie Barwick
- Hospital for Sick Children, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sarah Munns
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia
| | - Matthew N Cooper
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Bentley, WA, Australia
| | - Pamela Laird
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia.
- Department of Paediatrics, School of Medicine, University of WA, Perth, Australia.
- Department Physiotherapy, Perth Children's Hospital, Perth, WA, Australia.
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9
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Gill FJ, Cooper AL, Laird P, Leslie GD. Aboriginal perspectives on recognising clinical deterioration in their child and communicating concerns to clinicians. J Pediatr Nurs 2022; 63:e10-e17. [PMID: 34801328 DOI: 10.1016/j.pedn.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/13/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the perspectives of family members of Aboriginal children about a) their involvement in recognising clinical deterioration in a hospital setting and b) the effectiveness of a poster designed to promote family involvement. BACKGROUND To assist in the early recognition and response to clinical deterioration for hospitalised children, many escalation of care processes now include family involvement. Little is currently known about the perspectives of Australian Aboriginal families in recognising deterioration in their child and raising the alarm, or if current escalation of care systems meet the needs of Aboriginal families. DESIGN Qualitative pragmatist approach using semi-structured interviews. METHODS Seven interviews were conducted with five mothers and two grandmothers of Aboriginal children who were inpatients at a children's hospital. Thematic analysis was undertaken. FINDINGS Two themes were identified: Theme one was: Family role in recognising and responding to clinical deterioration, with two subthemes of knowing when to worry and communicating concerns. Participants reported that some families needed more knowledge to recognise clinical deterioration. Communication barriers between families and clinicians were identified. Theme two was: Effective visual communication with three subthemes of linguistic clarity, visual appeal and content. CONCLUSIONS Additional strategies are needed to promote effective communication between clinicians and families of Aboriginal children in hospital. Posters were considered effective, particularly if including a cultural connection, images and simplified language. PRACTICE IMPLICATIONS These insights provide important information for health professionals and health service managers to be aware that additional communication strategies are required to support Aboriginal family involvement in recognising clinical deterioration and escalation of care.
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Affiliation(s)
- Fenella J Gill
- Nursing Research, Perth Children's Hospital, 15 Hospital Avenue, Nedlands 6009, WA, Australia; School of Nursing, Curtin University, Perth 6102, WA, Australia; Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Alannah L Cooper
- School of Nursing, Curtin University, Perth 6102, WA, Australia.
| | - Pamela Laird
- Physiotherapy Department, Perth Children's Hospital, 15 Hospital Avenue, Nedlands 6009, WA, Australia; Breath Team, Wal-Yan Respiratory Research Centre, Telethon Kids Institute, 15 Hospital Avenue, Nedlands 6009, WA, Australia; School of Medicine, University of Western Australia, 35 Stirling Highway, Crawley 6009, WA, Australia.
| | - Gavin D Leslie
- School of Nursing, Curtin University, Perth 6102, WA, Australia.
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10
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Lau GTY, Laird P, Stevenson PG, Schultz A. Frequency of protracted bacterial bronchitis and management pre-respiratory referral. J Paediatr Child Health 2022; 58:97-103. [PMID: 34352136 DOI: 10.1111/jpc.15665] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/29/2021] [Accepted: 07/15/2021] [Indexed: 11/28/2022]
Abstract
AIM To determine the frequency of protracted bacterial bronchitis (PBB) in children referred to tertiary care with chronic cough and describe management prior to referral. METHODS A retrospective cohort study of all new patients with a history of ≥4 weeks of cough seen at the only tertiary paediatric outpatient respiratory service in Western Australia between July 2018 and June 2019. Medical records were reviewed until a final diagnosis was documented or otherwise for a period of 18 months. RESULTS PBB was the most common cause and comprised 37.9% of all children referred to tertiary respiratory care with chronic cough. In children with PBB, the median cough duration at the time of first specialist review was 5.1 months (IQR 2.1-12.0 months). The most common referral source of PBB was primary practice (40.9%) and the most common working diagnosis pre-referral was asthma (15.9%). Seventy-eight percent of children with PBB had an ongoing cough at their first respiratory review, and of these, only 13.5% had been prescribed 4 weeks of antibiotics prior to their respiratory review. Asthma treatment had been prescribed for 34.0% of children with PBB. CONCLUSION PBB is the most common cause of chronic cough in children referred to tertiary respiratory care and is frequently misdiagnosed and undertreated pre-referral. There is a need to facilitate diagnosis and optimal management of PBB in primary care, which could result in earlier symptom resolution and potentially limit disease progression to bronchiectasis.
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Affiliation(s)
- Gloria T Y Lau
- Department of Respiratory, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Pamela Laird
- Department of Physiotherapy, Perth Children's Hospital, Perth, Western Australia, Australia.,Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia.,Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Paul G Stevenson
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Andre Schultz
- Department of Respiratory, Perth Children's Hospital, Perth, Western Australia, Australia.,Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia.,Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
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11
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Meumann EM, Horan K, Ralph AP, Farmer B, Globan M, Stephenson E, Popple T, Boyd R, Kaestli M, Seemann T, Vandelannoote K, Lowbridge C, Baird RW, Stinear TP, Williamson DA, Currie BJ, Krause VL. Tuberculosis in Australia's tropical north: a population-based genomic epidemiological study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 15:100229. [PMID: 34528010 PMCID: PMC8350059 DOI: 10.1016/j.lanwpc.2021.100229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/03/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Northern Territory (NT) has the highest tuberculosis (TB) rate of all Australian jurisdictions. We combined TB public health surveillance data with genomic sequencing of Mycobacterium tuberculosis isolates in the tropical 'Top End' of the NT to investigate trends in TB incidence and transmission. METHODS This retrospective observational study included all 741 culture-confirmed cases of TB in the Top End over three decades from 1989-2020. All 497 available M. tuberculosis isolates were sequenced. We used contact tracing data to define a threshold pairwise SNP distance for hierarchical single linkage clustering, and examined putative transmission clusters in the context of epidemiologic information. FINDINGS There were 359 (48%) cases born overseas, 329 (44%) cases among Australian First Nations peoples, and 52 (7%) cases were Australian-born and non-Indigenous. The annual incidence in First Nations peoples from 1989-2019 fell from average 50.4 to 11.0 per 100,000 (P<0·001). First Nations cases were more likely to die from TB (41/329, 12·5%) than overseas-born cases (11/359, 3·1%; P<0·001). Using a threshold of ≤12 SNPs, 28 clusters of between 2-64 individuals were identified, totalling 250 cases; 214 (86%) were First Nations cases and 189 (76%) were from a remote region. The time between cases and past epidemiologically- and genomically-linked contacts ranged from 4·5 months to 24 years. INTERPRETATION Our findings support prioritisation of timely case detection, contact tracing augmented by genomic sequencing, and latent TB treatment to break transmission chains in Top End remote hotspot regions.
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Affiliation(s)
- Ella M Meumann
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
- Territory Pathology, Royal Darwin Hospital, Darwin, Australia
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Kristy Horan
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Anna P Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Belinda Farmer
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Maria Globan
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Elizabeth Stephenson
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Tracy Popple
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Rowena Boyd
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Mirjam Kaestli
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Torsten Seemann
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Koen Vandelannoote
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Christopher Lowbridge
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Robert W. Baird
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
- Territory Pathology, Royal Darwin Hospital, Darwin, Australia
| | - Timothy P. Stinear
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Deborah A. Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Bart J. Currie
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Vicki L. Krause
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
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12
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Laird P, Chang AB, Jacky J, Lane M, Schultz A, Walker R. Conducting decolonizing research and practice with Australian First Nations to close the health gap. Health Res Policy Syst 2021; 19:127. [PMID: 34551774 PMCID: PMC8456666 DOI: 10.1186/s12961-021-00773-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
The purpose of this paper is to highlight a perspective for decolonizing research with Australian First Nations and provide a framework for successful and sustained knowledge translation by drawing on the recent work conducted by a research group, in five remote communities in North-Western Australia. The perspective is discussed in light of national and international calls for meaningful and dedicated engagement with First Nations people in research, policy and practice, to help close the health gap between First Nations and other Australians.
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Affiliation(s)
- Pamela Laird
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia. .,Department of Physiotherapy, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA, 6009, Australia. .,The Child Health Division Menzies School of Health Research, Darwin, NT, Australia.
| | - Anne B Chang
- The Child Health Division Menzies School of Health Research, Darwin, NT, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,The Centre of Children's Health Research, Australian Centre for Health Services Innovation, Qld University of Technology, Brisbane, QLD, Australia
| | - John Jacky
- Kulunga, Telethon Kids Institute, Broome, WA, Australia
| | - Mary Lane
- Broome Regional Aboriginal Medical Service, Broome, WA, Australia
| | - André Schultz
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Department of Paediatrics, School of Medicine, University of WA, Perth, Australia.,Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Roz Walker
- School of Indigenous Studies, Poche Centre for Indigenous Health, University of Western Australia, Perth, WA, Australia
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13
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Respiratory follow-up to improve outcomes for Aboriginal children: twelve key steps. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 15:100239. [PMID: 34528014 PMCID: PMC8355903 DOI: 10.1016/j.lanwpc.2021.100239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/20/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022]
Abstract
Background Among Aboriginal children, the burden of acute respiratory tract infections (ALRIs) with consequent bronchiectasis post-hospitalisation is high. Clinical practice guidelines recommend medical follow-up one-month following discharge, which provides an opportunity to screen and manage persistent symptoms and may prevent bronchiectasis. Medical follow-up is not routinely undertaken in most centres. We aimed to identify barriers and facilitators and map steps required for medical follow-up of Aboriginal children hospitalised with ALRIs. Methods Our qualitative study used a knowledge translation and participatory action research approach, with semi-structured interviews and focus groups, followed by reflexive thematic grouping and process mapping. Findings Eighteen parents of Aboriginal children hospitalised with ALRI and 144 Australian paediatric hospital staff participated. Barriers for parents were lack of information about their child's condition and need for medical follow-up. Facilitators for parents included doctors providing disease specific health information and follow-up instructions. Staff barriers included being unaware of the need for follow-up, skills in culturally responsive care and electronic discharge system limitations. Facilitators included training for clinicians in arranging follow-up and culturally secure engagement, with culturally responsive tools and improved discharge processes. Twelve-steps were identified to ensure medical follow-up. Interpretation We identified barriers and enablers for arranging effective medical follow-up for Aboriginal children hospitalised with ALRIs, summarised into four-themes, and mapped the steps required. Arranging effective follow-up is a complex process involving parents, hospital staff, hospital systems and primary healthcare services. A comprehensive knowledge translation approach may improve the follow-up process. Funding State and national grants and fellowships.
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14
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Butten K, Jones L, Newcombe PA, Chang AB, Sheffield JK, O'Grady KAF, Johnson NW, Bell AM, Ross G, Toombs M. Development and validation of a parent-proxy health-related quality of life survey for Australian First Nations children. BMJ Open 2021; 11:e046007. [PMID: 34400446 PMCID: PMC8370500 DOI: 10.1136/bmjopen-2020-046007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Within Australia, Aboriginal and Torres Strait Islander (First Nations) populations perceive health and well-being differently to non-Indigenous Australians. Existing health-related quality of life (HR-QoL) measurement tools do not account for these differences. The objective of this study was to develop and validate a culturally specific parent-proxy HR-QoL measurement tool for First Nations children. DESIGN Scale development was informed by parents/carers of children with a chronic illness and an expert panel. The preliminary 39-item survey was reviewed (n=12) and tested (n=163) with parents/carers of First Nations children aged 0-12 years at baseline with comparative scales: the Kessler Psychological Distress Scale, generic HR-QoL (Paediatric QoL Inventory 4.0, PedsQL4.0) and Spence Children's Anxiety Scale, and repeated (n=46) 4 weeks later. Exploratory Factor Analysis was used for scale reduction. Reliability and validity were assessed by internal consistency, test-retest, and correlations with comparison scales. RESULTS Items within our First Nations-Child Quality of Life (FirstNations-CQoL) were internally consistent with Cronbach's alpha coefficients of ≥0.7 (quality of life, 0.808; patient experience, 0.880; patient support, 0.768) and overall test-retest reliability was good (r=0.75; 95% CI 0.593 to 0.856). Convergent validity was observed with the PedsQL4.0 with Pearson's coefficients of r=0.681 (ages 2-4 years); r=0.651 (ages 5-12 years) and with the Kessler Psychological Distress scale (r=-0.513). Divergent validity against the Spence Anxiety Scale was not demonstrated. CONCLUSIONS The FirstNations-CQoL scale was accepted by the participants, reliable and demonstrated convergent validity with comparison measures. This tool requires further evaluation to determine responsiveness, its minimal important difference and clinical utility.
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Affiliation(s)
- Kaley Butten
- Institute of Health & Biomedical Innovation, Queensland University of Technology - QUT, Brisbane, Queensland, Australia
| | - Lee Jones
- Institute of Health & Biomedical Innovation, Queensland University of Technology - QUT, Brisbane, Queensland, Australia
| | - Peter A Newcombe
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Darwin, Queensland, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jeanie K Sheffield
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Kerry-Ann F O'Grady
- Institute of Health & Biomedical Innovation, Queensland University of Technology - QUT, Brisbane, Queensland, Australia
| | - Newell W Johnson
- Menzies Health Institute Queensland and School of Dentistry and Oral Health, Gold Coast Campus - Griffith University, Gold Coast, Queensland, Australia
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Anna Maria Bell
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Greggory Ross
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Maree Toombs
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
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15
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Prime SJ, Carter HE, McPhail SM, Petsky HL, Chang AB, Graves N, Marchant JM. Chronic wet cough in Australian children: Societal costs and quality of life. Pediatr Pulmonol 2021; 56:2707-2716. [PMID: 33939893 DOI: 10.1002/ppul.25438] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/13/2021] [Accepted: 04/12/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Children with chronic wet cough regularly use the health system, experience considerable variability in care, have reduced quality of life (QoL), and, left untreated, poorer health outcomes. Despite this, little is known about the associated economic burden. This study aimed to quantify the cost of chronic wet cough among Australian children from the perspectives of families and the health system. METHODS A cost of illness study was conducted at the Queensland Children's Hospital, Brisbane, using data on 91 children newly referred to a respiratory specialist between July 2015 and January 2017 with a history of chronic wet cough (>4 weeks) of unknown etiology. Administrative and parent-reported data were used to estimate costs (reported in 2019 Australian Dollars [AUD]) for up to 12 months before and following initial pulmonology consultation. QoL was assessed for the same periods. RESULTS Mean cost per child-month during the average 9.8 months of observation preceding pulmonology consultation was AUD689 (95% confidence interval [CI] 534-844) increasing to AUD1339 (95% CI 1051-1628) during the average 11.9 months following pulmonology consultation. This translated to a total of AUD1.9 million across the study period, with families bearing 26.4% of costs. Aspiration and bronchiectasis were associated with higher total costs. For all etiologies, cough-specific QoL improved following pulmonology consultation, while direct medical costs declined. CONCLUSION Childhood chronic wet cough is associated with substantial societal costs. The observed cost decrease after specialist diagnosis suggests that early referral to a respiratory specialist may have economic benefits, in addition to the known health benefits.
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Affiliation(s)
- Samantha J Prime
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Clinical Informatics Directorate, Metro South Health, Woolloongabba, Queensland, Australia
| | - Helen L Petsky
- School of Nursing and Midwifery, Griffith University and Menzies Health Institute Queensland, Brisbane, Queensland, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Nicholas Graves
- Health Service and Systems Research Program, Duke-NUS Medical School, Singapore
| | - Julie M Marchant
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
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16
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Perkes S, Bonevski B, Mattes J, Hall K, Gould GS. Respiratory, birth and health economic measures for use with Indigenous Australian infants in a research trial: a modified Delphi with an Indigenous panel. BMC Pediatr 2020; 20:368. [PMID: 32758202 PMCID: PMC7409441 DOI: 10.1186/s12887-020-02255-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/23/2020] [Indexed: 01/26/2023] Open
Abstract
Background There is significant disparity between the respiratory health of Indigenous and non-Indigenous Australian infants. There is no culturally accepted measure to collect respiratory health outcomes in Indigenous infants. The aim of this study was to gain end user and expert consensus on the most relevant and acceptable respiratory and birth measures for Indigenous infants at birth, between birth and 6 months, and at 6 months of age follow-up for use in a research trial. Methods A three round modified Delphi process was conducted from February 2018 to April 2019. Eight Indigenous panel members, and 18 Indigenous women participated. Items reached consensus if 7/8 (≥80%) panel members indicated the item was ‘very essential’. Qualitative responses by Indigenous women and the panel were used to modify the 6 months of age surveys. Results In total, 15 items for birth, 48 items from 1 to 6 months, and five potential questionnaires for use at 6 months of age were considered. Of those, 15 measures for birth were accepted, i.e., gestational age, birth weight, Neonatal Intensive Care Unit (NICU) admissions, length, head circumference, sex, Apgar score, substance use, cord blood gas values, labour, birth type, health of the mother, number people living in the home, education of mother and place of residence. Seventeen measures from 1-to 6 months of age were accepted, i.e., acute respiratory symptoms (7), general health items (2), health care utilisation (6), exposure to tobacco smoke (1), and breastfeeding status (1). Three questionnaires for use at 6 months of age were accepted, i.e., a shortened 33-item respiratory questionnaire, a clinical history survey and a developmental questionnaire. Conclusions In a modified Delphi process with an Indigenous panel, measures and items were proposed for use to assess respiratory, birth and health economic outcomes in Indigenous Australian infants between birth and 6 months of age. This initial step can be used to develop a set of relevant and acceptable measures to report respiratory illness and birth outcomes in community based Indigenous infants.
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Affiliation(s)
- Sarah Perkes
- Hunter Medical Research Institute and School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia.
| | - Billie Bonevski
- Hunter Medical Research Institute and School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
| | - Joerg Mattes
- Hunter Medical Research Institute and School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
| | - Kerry Hall
- First Peoples Health Unit, (FPHU) Griffith University, Southport, Queensland, 4215, Australia
| | - Gillian S Gould
- Hunter Medical Research Institute and School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
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17
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Laird P, Walker R, Lane M, Totterdell J, Chang AB, Schultz A. Recognition and Management of Protracted Bacterial Bronchitis in Australian Aboriginal Children: A Knowledge Translation Approach. Chest 2020; 159:249-258. [PMID: 32673622 DOI: 10.1016/j.chest.2020.06.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/05/2020] [Accepted: 06/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic wet cough in children is the hallmark symptom of protracted bacterial bronchitis (PBB) and if left untreated can lead to bronchiectasis, which is prevalent in Indigenous populations. Underrecognition of chronic wet cough by parents and clinicians and underdiagnosis of PBB by clinicians are known. RESEARCH QUESTION We aimed to improve recognition and management of chronic wet cough in Aboriginal children using knowledge translation (KT), a methodologic approach that can be adapted for use in Indigenous contexts to facilitate effective and sustained translation of research into practice. STUDY DESIGN AND METHODS A mixed-methods KT study undertaken at a remote-based Aboriginal primary medical service (February 2017 to December 2019). Our KT strategy included the following: (1) culturally secure (ie, ensuring Aboriginal people are treated regarding their unique cultural needs and differences) knowledge dissemination to facilitate family health seeking for chronic wet cough in children, and (2) an implementation strategy to facilitate correct diagnosis and management of chronic wet cough and PBB by physicians. RESULTS Post-KT, health seeking for chronic wet cough increased by 184% (pre = eight of 630 children [1.3%], post = 23 of 636 children [3.6%]; P = .007; 95% CI, 0.7%-4.0%). Physician proficiency in management of chronic wet cough improved significantly as reflected by improved chronic cough-related quality of life (P < .001; 95% CI, 0.8-3.0) and improved physician assessment of cough quality (P < .001; 95% CI, 10.4%-23.0%), duration (P < .001; 95% CI, 11.1%-24.1%), and appropriate antibiotic prescription (P = .010; 95% CI, 6.6%-55.7%). INTERPRETATION Health seeking for children with chronic wet cough can be facilitated through provision of culturally secure health information. Physician proficiency in the management of PBB can be improved with KT strategies which include training in culturally informed management, leading to better health outcomes. Comprehensive strategies that include both families and health systems are required to ensure that chronic wet cough in children is detected and optimally managed.
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Affiliation(s)
- Pam Laird
- Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Australia; Department of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Physiotherapy, Perth Children's Hospital, Australia.
| | - Roz Walker
- School of Indigenous Studies, Poche Centre for Indigenous Health, University of Western Australia, Australia
| | - Mary Lane
- Broome Aboriginal Medical Service, Australia
| | - James Totterdell
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Australia
| | - Anne B Chang
- Child Health Division Menzies School of Health Research, Department of Respiratory Medicine, Queensland Children's Hospital, Australia; Center of Children's Health Research, Australian Centre For Health Services Innovation, Qld University of Technology, Australia
| | - André Schultz
- Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Australia; Department of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Australia
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18
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Laird P, Totterdell J, Walker R, Chang AB, Schultz A. Prevalence of chronic wet cough and protracted bacterial bronchitis in Aboriginal children. ERJ Open Res 2019; 5:00248-2019. [PMID: 31832431 PMCID: PMC6899340 DOI: 10.1183/23120541.00248-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/17/2019] [Indexed: 12/14/2022] Open
Abstract
Background Chronic wet cough, the most common symptom of a disease spectrum that encompasses protracted bacterial bronchitis (PBB) and bronchiectasis, is common among Aboriginal children. In the absence of any community prevalence data, and with the high burden of respiratory disease and the European Respiratory Society task force's recommendation to identify disease burden, we determined the prevalence of chronic wet cough and PBB in young Aboriginal children in four remote communities in north Western Australia. Methods A whole-population, prospective study was conducted. Aboriginal children aged ≤7 years were clinically assessed for chronic wet cough by paediatric respiratory clinicians between July 2018 and May 2019. Where children had a wet cough but parents reported a short or uncertain cough duration, children were followed up 1 month later. A medical record audit 6 weeks to 3 months later was used to determine those children with chronic wet cough who had PBB (based on response to antibiotics). Results Of the 203 children, 191 (94%; median age 3.5 years, range 0–7 years) were enrolled. At the initial visit, chronic wet cough was present in 21 (11%), absent in 143 (75%) and unknown in 27 (14%). By follow-up, the total prevalence of chronic wet cough was 13% (95% CI 8–19%) and 10% (95% CI 7–17%) for PBB. Chronic wet cough was more common in the two communities with unsealed roads (19%) compared to the two with sealed roads (7%). Conclusion Given the relatively high prevalence, strategies to address reasons for and treatment of chronic wet cough and PBB in young Aboriginal children in remote north Western Australia are required. Prevalence of chronic wet cough and protracted bacterial bronchitis in Aboriginal children in remote, north Western Australia is high. There is a need to implement strategies to detect and manage these entities and measure prevalence in other settings.http://bit.ly/33QLzDA
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Affiliation(s)
- Pamela Laird
- Children's Lung Health Division, Telethon Kids Institute, Perth, Australia.,Dept of Physiotherapy, Perth Children's Hospital, Perth, Australia.,School of Medicine, Dept of Paediatrics, University of Western Australia, Perth, Australia
| | - James Totterdell
- Children's Lung Health Division, Telethon Kids Institute, Perth, Australia
| | - Roz Walker
- Poche Centre for Indigenous Health, School of Indigenous Studies, University of Western Australia, Perth, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Queensland University of Technology, Brisbane, Australia
| | - André Schultz
- Children's Lung Health Division, Telethon Kids Institute, Perth, Australia.,School of Medicine, Dept of Paediatrics, University of Western Australia, Perth, Australia.,Dept of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Australia
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Laird P, Walker R, Lane M, Chang AB, Schultz A. We won't find what we don't look for: Identifying barriers and enablers of chronic wet cough in Aboriginal children. Respirology 2019; 25:383-392. [DOI: 10.1111/resp.13642] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 05/03/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Pamela Laird
- Telethon Kids InstituteThe University of Western Australia Perth WA Australia
- Division of Paediatrics, School of MedicineThe University of Western Australia Perth WA Australia
- Departments of Respiratory Medicine and Physiotherapy, Perth Children's Hospital Perth WA Australia
| | - Roz Walker
- Telethon Kids InstituteThe University of Western Australia Perth WA Australia
- Division of Paediatrics, School of MedicineThe University of Western Australia Perth WA Australia
| | - Mary Lane
- Broome Regional Aboriginal Medical Service Broome WA Australia
| | - Anne B. Chang
- Child Health Division, Menzies School of Health ResearchCharles Darwin University Darwin NT Australia
| | - André Schultz
- Telethon Kids InstituteThe University of Western Australia Perth WA Australia
- Division of Paediatrics, School of MedicineThe University of Western Australia Perth WA Australia
- Departments of Respiratory Medicine and Physiotherapy, Perth Children's Hospital Perth WA Australia
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