Article Text
Abstract
Objective To assess the proportion of Australian children aged 0–15 years that received care in line with clinical practice guidelines (CPGs) for upper respiratory tract infections (URTIs).
Design Retrospective medical record review using a multistage sampling strategy.
Setting General practices, hospital emergency departments and hospital inpatient service providers in three Australian states.
Participants Children aged up to 15 years who received care for URTI in 2012 and 2013.
Primary and secondary outcome measures The primary assessment was estimated adherence with 14 indicators of appropriate care as documented in medical records. Indicators were extracted from national and international CPGs and ratified by experts. Secondary assessment was adherence to two bundles of indicators (diagnostic symptoms and medical history taking), where all indicators must be adherent for the bundle to be scored as adherent.
Results There were 1653 children with one or more assessments of URTI care to CPG adherence. Over half of the children were under 3 years of age, with roughly equal numbers of males and females. Three indicators had fewer than 25 visits so were not reported. Overall adherence ranged from 0.5% for ‘documented advice around antibiotics’ to 88.3% for ‘documentation of medical history’. Adherence with Bundle A (documentation of all three definitive symptoms) was 43.1% (95% CI 32.8% to 54.0%) and Bundle B (documentation of all four indicators of medical history) was 30.2% (95% CI 20.9% to 40.9%).
Conclusions URTIs in children are common, usually self-limiting, conditions that are allocated considerable resources. The results suggest that there may be a need for more thorough holistic assessment of the patient and improved documentation. Since inappropriate prescription of antibiotics for URTIs is still a known problem in Australia, there is a need for consistent, clear communication around antibiotics’ lack of impact on symptoms and a high association with undesirable side effects.
- Upper respiratory tract infection
- guideline adherence
- health care quality indicators
- paediatrics
- child health
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Footnotes
Contributors JB and PDH designed the overall study. SJ and HMW contributed to design of URTI study. JB, PDH, GA, HPT and CJM carried out the collection and statistical analysis of the data. JL drafted the manuscript and was responsible for coordination of all aspects of the work. KC and LAE reviewed and made substantial contributions to earlier drafts. All authors contributed to the interpretation of results and the final manuscript.
Funding This work was supported by an Australian National Health and Medical Research Council Partnership grant (APP1065898), with contributions by the National Health and Medical Research Council, Bupa Health Foundation, Sydney Children’s Hospital Network, New South Wales Kids and Families, Children’s Health Queensland and the South Australian Department of Health (SA Health).
Competing interests None declared.
Ethics approval Primary ethics approval was received from hospital networks (HREC/14/SCHN/113; HREC/14/QRCH/91; HREC/14/WCHN/68) and the Royal Australian College of General Practitioners (NREEC 14-008), and site-specific approvals from 34 sites.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All additional data are provided in online supplementary appendix.
Patient consent for publication Not required.