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Assessing the Quality of Clinical Care for Children with Chronic Wet Cough Prior to Respiratory Specialist Consultation: Targets for Improvement

Background: Childhood chronic wet cough is associated with poor health outcomes and increased health service utilisation, however little is known about the quality of primary care currently provided.

Aim: To assess the quality of care provided to children with chronic wet cough prior to referral to a respiratory specialist physician.

Design: Prospective cross sectional study.

Setting: Paediatric respiratory specialist clinics in Brisbane, Australia at (a) Lady Cilento Children’s Hospital, a public tertiary facility and (b) Wesley Hospital, a private facility.

Participants: Children newly referred to a paediatric respiratory specialist between July 2015 and January 2017 with a history of chronic (>4 weeks) wet cough of unknown aetiology.

Main outcome measure’s: The quality of pre-respiratory specialist care was assessed against a 10-item quality indicator tool where a score of 0 reflects poor care and 10 reflects high quality care. The quality indicator tool encompassed both clinical care and referral practices.

Results: The median age of 110 children enrolled was 1.9 years (IQR 1.2, 4.1). Children had a history of coughing illnesses for a median of 53.2 weeks (IQR 24.9, 127.6) prior to receiving a referral to a respiratory specialist. The quality indicator score rated for referrals was median 6 (IQR 5, 8), with 48% referrals from general practitioners scoring between 0-5. Main indicators of poor care were the inappropriate use of antibiotics and delayed specialist referral practices.

Conclusion: Children referred for specialist care were young and had a long history of coughing illness. Based on a quality indicator tool the preliminary care provided prior to referral is poor. Barriers to improving pre-specialist care need to be evaluated and include targeted education, particularly for primary care physicians. 

Author(s): Samantha J Prime, Julie Marchant, Anne B Chang, Nicholas Graves and Helen L Petsky

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