Asthma in children: gaps between current management and best practice.
OBJECTIVE
To determine the extent to which steps three to six of the Australian six-step asthma management plan are being implemented in the community and to identify barriers to the adoption of best practice asthma management.


METHODS
A cross-sectional descriptive study was conducted at the Royal Children's Hospital and Sunshine Hospital, Melbourne. Two hundred and thirty-one 2-5-year old children who visited the emergency department for asthma were enrolled in the study. Main outcome measures were frequency of asthma management practices and barriers, as measured by parent-completed questionnaire.


RESULTS
Gaps: 51% of parents do not feel they have enough information about asthma triggers, more than 60% of children with persistent or frequent episodic asthma are not using regular preventive medication, 48% do not have a written action plan, 39% have not had their asthma reviewed in the last 6 months, and 38% of parents do not feel that they have enough information about their child's asthma. Areas where current practice was close to best practice: 83% of doctors had talked to parents about what causes or 'triggers' their child's asthma, less than 1% of children are using puffers without a spacer, 83% of parents who had an action plan used it for the current visit to the emergency department.


CONCLUSIONS
Large gaps still exist between current management and best practice in this group of emergency department attenders. Improvements in asthma management could be achieved if the child's asthma doctor requested review visits for asthma, provided an action plan and followed best practice in relation to asthma medications.
Haby
M M
MM
Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia.
Powell
C V E
CV
Oberklaid
F
F
Waters
E B
EB
Robertson
C F
CF
D001249:Asthma / Q000175:diagnosis / Q000628:therapy*; D001315:Australia; D019985:Benchmarking; D016009:Chi-Square Distribution; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000592:standards* / Q000639:trends; D005194:Family Practice / Q000592:standards* / Q000639:trends; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011336:Probability; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014505:Urban Population