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

• Published in: The Lancet Regional Health - Western Pacific
• Main Authors: Laird, Pamela J., Chang, Anne B., Walker, Roz, Barwick, Melanie, Whitby, Jack, Cooper, Matthew N., Gill, Fenella, McKinnon, Elizabeth, Schultz, André
• Format: Article in Journal/Newspaper
• Language: English
• Published: Elsevier Ltd 2023
• Subjects: Chest infections; First nations children; Implementation science; Knowledge translation; First Nations
• Online Access: https://doi.org/10.1016/j.lanwpc.2023.100708; https://researchportal.murdoch.edu.au/esploro/outputs/journalArticle/Evaluation-of-the-implementation-and-clinical/991005590369807891; https://researchportal.murdoch.edu.au/view/delivery/61MUN_INST/12144867670007891/13144867660007891

Aboriginal children hospitalised with acute lower respiratory infections (ALRIs) are at-risk of developing bronchiectasis, which can progress from untreated protracted bacterial bronchitis, often evidenced by a chronic (>4 weeks) wet cough following discharge. We aimed to facilitate follow-up for Aboriginal children hospitalised with ALRIs to provide optimal management and improve their respiratory health outcomes. We implemented an intervention to facilitate medical follow-up four weeks after hospital discharge from a paediatric hospital in Western Australia. The intervention included six-core components that focused on parents, hospital staff and hospital processes. Both health and implementation outcomes were measured for children grouped by three distinct temporal periods of recruitment: (i) nil-intervention, recruited after hospital admission; (ii) health-information only, received during recruitment at hospital admission, pre-intervention; (iii) post-intervention. The primary outcome was the cough-specific quality-of-life score (PC-QoL) in children with a chronic wet cough following discharge. Of the 214 patients that were recruited, 181 completed the study. Follow-up rates one-month post-discharge were higher in the post-intervention (50.7%) than the nil-intervention (13.6%) and health-information (17.1%) groups. PC-QoL in children with a chronic wet cough was also improved in the post-intervention group compared the health information and nil-intervention groups (difference in means between nil-intervention and post-intervention groups = 1.83, 95% CI: 0.75, 2.92, p = 0.002), aligning with an increase in the percentage who received evidence-based treatment, namely antibiotics at one-month post-discharge (57.9% versus 13.3%). Implementation of our co-designed intervention to facilitate effective and timely medical follow-up for Aboriginal children hospitalised with ALRIs improved their respiratory health outcomes. State, national grants and fellowships.