Respiratory follow-up to improve outcomes for Aboriginal children: Twelve key steps

Pamela Laird, Roz Walker, Fenella J. Gill, Jack Whitby, Anne B. Chang, André Schultz

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    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.

    Original languageEnglish
    Article number100239
    Pages (from-to)1-16
    Number of pages16
    JournalThe Lancet Regional Health - Western Pacific
    Volume15
    DOIs
    Publication statusPublished - Oct 2021

    Bibliographical note

    Funding Information:
    Dr Laird was funded by a Perth Children's Hospital Foundation New Investigator Grant, A/Prof Schultz is supported by an NHMRC Trip fellowship [Grant APP1168022]. Prof Chang is supported by an NHMRC Practitioner Fellowship [Grant 1058213] and a Queensland Children's Hospital Foundation top-up [Grant 50286], and has received multiple NHMRC grants related to topics of cough and bronchiectasis including Centre of Research Excellence grants for lung disease [Grant 1040830] among Indigenous children and bronchiectasis [Grant 1170958].

    Funding Information:
    Dr Laird was funded by a Perth Children's Hospital Foundation New Investigator Grant, A/Prof Schultz is supported by an NHMRC Trip fellowship [Grant APP1168022]. Prof Chang is supported by an NHMRC Practitioner Fellowship [Grant 1058213] and a Queensland Children's Hospital Foundation top-up [Grant 50286], and has received multiple NHMRC grants related to topics of cough and bronchiectasis including Centre of Research Excellence grants for lung disease [Grant 1040830] among Indigenous children and bronchiectasis [Grant 1170958]. Conceptualization: PL, AS, RW, FG, AC. Data Curation: PL. Figures: PL, Formal Analysis: PL, RW, FG, AS, JW. Funding acquisition: AS, PL, RW, FG, AC. Investigation: PL, AS, RW, FG, JW. Literature search: PL, Methodology: AS, PL, RW, FG, AC. Project Administration: PL. Resources: PL, AS, AC, RW. Supervision: AS, AC, RW. Validation: PL, RW, AS, FG. Visualization: PL. Writing- original draft: PL, AS. Writing-review and editing: PL, AS, RW, FG, AC, JW. Data collected from the study has been included in the manuscript (Tables 4-7). The study protocol and informed consent forms are available if requested. The authors thank the local Aboriginal families and staff at the hospital for their support and collaboration in all aspects of the planning and operation of the study. The authors would like to thank the Aboriginal families and the staff at the hospital who agreed to participate in the study. We would like to thank the external stakeholders who provided valuable information to assist in developing processes for implementation. We would like to thank Sonali Dodangoda (BSc, MInfectDis), Wal-yan Centre for Respiratory Research, Telethon Kids Institute for creation of figures and infographics. The project was funded by the Western Australian Health Translation Network knowledge translation grant.

    Publisher Copyright:
    © 2021

    Copyright:
    Copyright 2021 Elsevier B.V., All rights reserved.

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