Impact of integrated care coordination on pediatric asthma hospital presentations.

Introduction: Frequent asthma attacks in children result in unscheduled hospital presentations. Patient centered care coordination can reduce asthma hospital presentations. In 2016, The Sydney Children's Hospitals Network launched the Asthma Follow up Integrated Care Initiative with the aim to reduce pediatric asthma emergency department (ED) presentations by 50% through developing and testing an integrated model of care led by care coordinators (CCs). Methods: The integrated model of care was developed by a multidisciplinary team at Sydney Children's Hospital Randwick (SCH,R) and implemented in two phases: Phase I and Phase II. Children aged 2-16 years who presented ≥4 times to the ED of the SCH,R in the preceding 12 months were enrolled in Phase I and those who had ≥4 ED presentations and ≥1 hospital admissions with asthma attack were enrolled in Phase II. Phase I included a suite of interventions delivered by CCs including encouraging parents/carers to schedule follow-up visits with GP post-discharge, ensuring parents/carers are provided with standard asthma resource pack, offering referrals to asthma education sessions, sending a letter to the child's GP advising of the child's recent hospital presentation and coordinating asthma education webinar for GPs. In addition, in Phase II CCs sent text messages to parents/carers reminding them to follow-up with the child's GP. We compared the change in ED visits and hospital admissions at baseline (6 months pre-enrolment) and at 6-and 12-months post-enrolment in the program. Results: During December 2016-January 2021, 160 children (99 in Phase I and 61 in Phase II) were enrolled. Compared to baseline at 6- and 12-months post-enrolment, the proportion of children requiring ≥1 asthma ED presentations reduced by 43 and 61% in Phase I and 41 and 66% in Phase II. Similarly, the proportion of children requiring ≥1 asthma hospital admissions at 6- and 12-months post-enrolment reduced by 40 and 47% in Phase I and 62 and 69% in Phase II. Conclusion: Our results support that care coordinator led integrated model of asthma care which enables integration of acute and primary care services and provides families with asthma resources and education can reduce asthma hospital presentations in children.

Asthma management self-efficacy in parents of primary school-age children.

The aim of this study was to investigate asthma management self-efficacy in parents of primary school-age children with asthma and to explore possible associations between parent asthma management self-efficacy, parent and child characteristics, asthma task difficulty and asthma management responsibility. A cross-sectional descriptive survey of 113 parents was conducted to assess the level of parent asthma management self-efficacy, asthma task difficulty and confidence, asthma responsibility and socio-demographic characteristics. The findings indicate that parents had higher self-efficacy for attack prevention than attack management. Parents had higher self-efficacy for asthma management tasks that are simple, skills based and performed frequently such as medication administration and less confidence and greater difficulty with tasks associated with judgement and decision-making. Multivariate linear regression analysis identified English language, child asthma responsibility and parent education as predictors of higher asthma management self-efficacy, while an older child was associated with lower parent asthma management self-efficacy. The implications of these results for planning and targeting health education and self-management interventions for parents and children are discussed.

Enhancing transformational facilitation skills for nurses seeking to support practice innovation.

AIMS: To provide an overview of the development, implementation and process evaluation of a programme for nurses seeking to develop the knowledge and skills required to facilitate practice innovation. METHOD: The 12 month facilitation in clinical practice programme was underpinned by transformational practice development (tPD) methodology. The programme included a series of workshops, active learning groups and was supported by experienced facilitators, using a co-facilitation model. Evaluation occurred continuously throughout the programme. RESULTS: Participants evaluated the programme positively and were able to apply their evolving knowledge and skills within their everyday practice. Their major areas of learning included active participation in their own learning, an increased valuing of diversity within the group and application of their learning in facilitation of practice development initiatives. The co-facilitation model was found to challenge and support ongoing development of the facilitators. CONCLUSIONS: Participation in the facilitation in clinical practice programme enhances nurses' knowledge and skills for undertaking tPD.

Modification and testing of the chronic disease compliance instrument to measure treatment compliance in adolescents with diabetes.

AIMS AND OBJECTIVES: To examine the factor structure and internal consistency of the Chronic Disease Compliance Instrument-Diabetes in an Australian sample of adolescents with diabetes, to modify the instrument and re-examine factor structure and internal consistency of subsequent scales and to examine the relationship between compliance behaviour and theoretically relevant explanatory factors. BACKGROUND: Compliance is a key challenge for adolescents with a chronic disease; however, valid and reliable self-report measures of compliance behaviour and explanatory factors for diabetes remain elusive, particularly applied in an Australian setting. DESIGN: Correlational design. METHODS: Participants were 133 adolescents (12-17 years) diagnosed with diabetes and receiving treatment at several health care settings in New South Wales. Participants voluntarily completed the self-report instrument while waiting to see their Physician/Clinical Nurse Consultant/Diabetes Educator. RESULTS: On logical modification of the instrument based on exploratory factor analysis and thorough review of item content, the instrument was shown to have sufficient factor structure and internal consistency. Further, eight of the 11 explanatory factor scales were significantly related to compliance behaviour (accounting for 31% of variance). CONCLUSIONS: The present study represents the first application of an established instrument to measure compliance to diabetes treatment among adolescents in an Australian sample and demonstrates that the instrument has sufficient factor structure and internal consistency in this setting. Findings provide a list of relevant factors for explaining compliance, which may be employed to guide the development of initiatives to increase the level of compliance to treatment among Australian adolescents with diabetes. RELEVANCE TO CLINICAL PRACTICE: The Chronic Disease Compliance Instrument-Diabetes is a tool that can help nurses with their clinical practice by allowing for more efficient identification of adolescent compliance to diabetes treatment, which may be used in conjunction with HbA1c values already employed.

Modification and testing of the chronic disease compliance instrument to measure treatment compliance in adolescents with asthma.

Compliance is a key challenge for adolescents with asthma, and valid and reliable measures of compliance behaviour and explanatory factors remain elusive, particularly in an Australian setting. This study aimed to examine the factor structure and internal consistency of the chronic disease compliance instrument - asthma in an Australian sample of adolescents with asthma, as well as the relationship between compliance behaviour and explanatory factors. Participants were 132 adolescents (12-17 years) diagnosed with asthma, who voluntarily completed the self-report instrument. Upon logical modification of the instrument based on exploratory factor analysis and review of item content, the chronic disease compliance instrument - asthma was shown to have sufficient factor structure and internal consistency in an Australian setting. Further, findings provide a list of relevant factors for explaining compliance behaviour, which may be employed to guide the development of initiatives to increase the level of compliance with treatment among Australian adolescents with asthma.

The role of parents in managing asthma in middle childhood: an important consideration in chronic care.

Asthma is a significant illness for Australian children and their families. In childhood, parents have the primary responsibility for managing asthma on a day-to-day basis, and therefore understanding the management of asthma by parents is important to nursing practice. Middle childhood (5-12 years) is an important time in the lives of children and families with asthma, as children commence school and spend increasing amounts of time away from direct parental care. In order to manage asthma during middle childhood, parents need to understand asthma as an illness, understand the treatment of asthma, be able to monitor and respond to changes in condition, manage other carers, manage asthma in the context of family life and guide the development of self-management responsibility in their child with asthma. While the scope of parent management in terms of asthma knowledge and treatment has been well explored in the literature, less is known about the process by which parents support the development of self-management responsibility in children with asthma.

The role of specialist nurses in improving treatment adherence in children with a chronic illness.

Adherence to medical treatment is an ongoing challenge for families and young people with chronic medical conditions. One factor that is likely to influence treatment success is the quality of professional relationships both within the health care team and between the family, child and professionals. This paper explores the topic of professional relationships and adherence and provides an example of how a multidisciplinary team can improve the health and quality of life of paediatric patients. More specifically, the paper argues for the crucial role of the specialist nurse in supporting patients and their relationships with the health care team.