Hospital readmissions for asthma increasing among children in Australia

Hospital readmissions for asthma among children aged 3 years and older in Australia increased from 2017 to 2018, researchers reported in Journal of Asthma.

“Our study highlights an increased burden of asthma hospital readmissions of approximately one in three children in 12 months compared to one in five a decade ago in Victoria, Australia, using a similar data linkage method and that most admissions and readmissions are among preschool-aged children,” Katherine Y.H. Chen, PhD, postdoctoral research fellow in the Health Services Group at Murdoch Children’s Research Institute and the department of general medicine at The Royal Children’s Hospital and the department of pediatrics at the University of Melbourne, Australia, and colleagues wrote. “Internationally, our 12-month readmission rates for pediatric asthma are high compared to North America and China.”

The Childhood Asthma Re-admissions study included 767 children aged 3 to 18 years who were admitted to three hospitals in Victoria, Australia, from 2017 to 2018 with an asthma diagnosis. All participants were followed for at least 12 months after the index asthma hospital admission until September 2019.

The primary outcome was hospital readmission with asthma or wheeze within 12 months. Secondary outcomes included ED re-presentation for asthma or wheeze and rescue oral corticosteroid use within 12 months.

Within 12 months, 34.3% of participants were readmitted to the hospital for asthma at least once, and 7.7% were readmitted within 30 days. Of those readmitted, 69.2% were aged 3 to 5 years and 26.2% were aged 6 to 11 years. Only 4.6% of children aged 12 to 18 years were readmitted to the hospital.

In addition, more than 40% of general practitioners reported guideline-discordant care for questions regarding children with persistent asthma with the strongest evidence for a non-null effect for odds of hospital readmission (OR = 1.57; 95% CI, 1-2.47; P = .05).

There were no hospital or home environmental factors associated with hospital readmissions for asthma in this cohort, according to the researchers.

The researchers also reported gaps in hospital care. Records showed more than one-third of children did not have a review of their inhaler technique and only about one-quarter were prescribed a preventer medication or asked to continue using it.

“Almost three-quarters were discharged without a preventer medication, and over 80% did not have a follow-up clinic booked at the hospital, often reserved for children with difficult-to-control asthma. Most families, therefore, need to navigate their child’s asthma follow-up with their [general practitioner],” Chen said in a press release.

The researchers said use of linked datasets for this study are important to objective measure the burden of asthma on health services.

“Our current dataset cannot verify whether the follow-up appointment was attended, whether caregivers had arranged follow-up post-discharge and if the medications were used as prescribed,” Harriet Hiscock, MD, consultant pediatrician, National Health and Medical Research Council Practitioner Fellow, associate director of research at the Centre for Community Child Health, director of the Royal Children’s Hospital Health Services Research Unit and group leader of health services at Murdoch Children’s Research Institute, Melbourne, Australia, said in the release. “Integrating datasets such as health services and medication use into clinical care will improve the clinician’s understanding of the child’s asthma control and medication adherence and would assist in providing targeted treatments.”

Reference:

• Hospital readmissions for asthma on the rise among children. Published July 6, 2022. Accessed July 7, 2022.