Asthmatic children from lower-income families are less likely to own an individualised asthma action plan.

AIM: This study aimed to explore the relationship between indicators of socio-economic status (SES) and prescription of a paediatric individualised asthma action plan (IAAP), as well as compliance with that plan. METHODS: Between May and September 2017, parents/carers of children aged 2-16 years who presented with acute respiratory symptoms and a prior diagnosis of asthma to the emergency department at one regional and one metropolitan hospital in NSW, Australia, were invited to participate in a questionnaire-based study. RESULTS: A total of 175 eligible participants were identified, of which 113 completed the questionnaire. Eighty-seven children had been prescribed an IAAP (77%). Forty-nine parents/carers reported non-compliance with that plan (56.3%). Children from low- to middle-income families were significantly less likely to have a plan (P = 0.001). Being an only child was associated with greater IAAP compliance (P = 0.007) and better asthma control (P = 0.035). No significant relationship between other indicators of SES and rates of plan ownership or compliance was demonstrated. CONCLUSION: Although relatively high in our study sample, IAAP ownership rates remain well below published guidelines. Given the income-based disparity in plan ownership, physicians must routinely prescribe plans to all asthmatics. Strategies to ensure IAAP ownership and promote their use, especially in the public health sector, would be valuable. Repeating a similar study with a larger sample size will allow more robust conclusions to be drawn regarding the impact of parental SES on compliance.

Performance of the Australian Developmental Screening Test in a clinical setting.

AIMS: The study aims to assess the sensitivity and specificity of the Australian Developmental Screening Test (ADST) in a clinical setting in detecting developmental concerns that warrant further assessment or treatment. METHODS: Clients referred to an inner Sydney Community Health Centre with developmental concerns were initially assessed using the ADST, followed within 12 weeks by an assessment using the Griffiths Mental Developmental Scales (GMDS) as the gold standard. RESULTS: Of the 65 eligible children, 46 (71%) had results indicating further assessment (42) or follow-up (4) was needed (using the criteria recommended in the ADST manual). However, of these only 21 (46%) had an abnormal GMDS. This gave a sensitivity of 95% but a specificity of only 52%. New threshold criteria for further assessment were developed and applied to three age groups. If children aged under 2 years are assessed using the standard ADST threshold, and children 2 years or older are assessed using the new ADST cut-off, then the tool has a sensitivity of 95%, a specificity of 82%, a positive likelihood ratio of 5.24 (95% CI 2.78, 9.88) and negative likelihood ratio of 0.06 (0.01, 0.40). CONCLUSIONS: Modified criteria for the ADST developed in this study showed good specificity and sensitivity for detection of developmental problems in this population, referred because of developmental concerns. Further testing to see if these new criteria perform well in a different population is now needed.