Evaluation of the implementation and clinical effects of an intervention to improve medical follow-up and health outcomes for Aboriginal children hospitalised with chest infections

Abstract

Background: Aboriginal children hospitalised with acute lower respiratory infections (ALRIs) are at-risk of developing bronchiectasis, which can progress from untreated protracted bacterial bronchitis, often evidenced by a chronic (>4 weeks) wet cough following discharge. We aimed to facilitate follow-up for Aboriginal children hospitalised with ALRIs to provide optimal management and improve their respiratory health outcomes.; Methods: We implemented an intervention to facilitate medical follow-up four weeks after hospital discharge from a paediatric hospital in Western Australia. The intervention included six-core components that focused on parents, hospital staff and hospital processes. Both health and implementation outcomes were measured for children grouped by three distinct temporal periods of recruitment: (i) nil-intervention, recruited after hospital admission; (ii) health-information only, received during recruitment at hospital admission, pre-intervention; (iii) post-intervention. The primary outcome was the cough-specific quality-of-life score (PC-QoL) in children with a chronic wet cough following discharge.; Findings: Of the 214 patients that were recruited, 181 completed the study. Follow-up rates one-month post-discharge were higher in the post-intervention (50.7%) than the nil-intervention (13.6%) and health-information (17.1%) groups. PC-QoL in children with a chronic wet cough was also improved in the post-intervention group compared the health information and nil-intervention groups (difference in means between nil-intervention and post-intervention groups = 1.83, 95% CI: 0.75, 2.92, p = 0.002), aligning with an increase in the percentage who received evidence-based treatment, namely antibiotics at one-month post-discharge (57.9% versus 13.3%).; Interpretation: Implementation of our co-designed intervention to facilitate effective and timely medical follow-up for Aboriginal children hospitalised with ALRIs improved their respiratory health outcomes.; Funding: State, national grants and fellowships.; Competing Interests: The project was funded by a 10.13039/501100006065WA Health Translation Network knowledge translation grant. Dr Laird was funded by a Perth Children's Hospital Foundation New Investigator Grant, A/Prof Schultz received salary support from an MRFF Investigator Grant [APP1193796] and Mineral Resources (Ltd). Prof Chang is supported by an 10.13039/501100000925NHMRC Practitioner Fellowship [Grant 1058213] and a Queensland Children's Hospital Foundation top-up [Grant 50286] and has received multiple 10.13039/501100000925NHMRC 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]. A/Prof Gill was funded by a 10.13039/501100006065WA Health Translation Network Fellowship. No disclosures declared for all other authors. (© 2023 The Authors.)