Need for better access to GPs to treat childhood asthma

Ollie has run out of enough fingers and toes to count how many times he’s been rushed to the emergency department after having an asthma attack.

The three-year-old has been admitted to hospital 48 times to treat his severe asthma. But mum Rachel Cornwell (pictured above) said the 45-minute trip into the hospital could be avoided if Ollie had a regular GP who was well equipped to handle complex asthma cases.

Ollie (pictured left) currently has injections and takes steroid medication, on top of his inhaler, to help decrease the number of asthma flare-ups.

“Ollie doesn’t see a GP for his asthma because it’s an uphill battle to get an appointment and consistent care,” she said.

“He goes from 100 to zero in a flash. Day two of an asthma flare-up he would need to have IV treatment or oxygen in hospital. It is incredibly stressful to see your child struggling to breathe.

“There was a point where we were going into the hospital fortnightly and Ollie wasn’t receiving follow up care. GPs just aren’t confident to treat him because of his history.”

Rachel said the COVID-19 pandemic further complicated access to a local doctor.

“During the height of the pandemic it was made even more difficult to see a doctor because they would want COVID-19 tests,” she said. “But when your child is having an asthma attack you don’t have 24 hours to wait for a result to come back.

“You can’t predict when your child is going to have an asthma flare-up, so you don’t have the luxury of booking an appointment in advance. It’s just easier and quicker to go to hospital.”

But Rachel said things had improved with Ollie since coming under the care of the Complex Asthma Service at The Royal Children’s Hospital.

She said the recent research by Murdoch Children’s Research Institute that highlighted opportunities to improve asthma care within the primary care network provided her family with hope.

“The research could lead to much better care for children with severe asthma,” she said. If we could see a regular GP who had the expertise to treat Ollie it would be a huge weight off our shoulders.”

The research, published in the Journal of Asthma and Archives of Diseases in Childhood, found frequent GP visits improve health outcomes for children with asthma, however, they are often irregular and inconsistent leading to an increase in hospital readmissions. 

The research involved 277 GPs and 767 caregivers of children aged 3-18 years who were admitted to one of three hospitals in Victoria with asthma.

It found only one in five participants visited their regular GP on more than 60 per cent of visits and 36 per cent saw a GP within seven days of being discharged from hospital for their asthma. Early follow-up and frequent GP visits were associated with reduced ED presentations, hospital readmissions and improved asthma outcomes.

Murdoch Children’s researcher Renee Jones said the low rate of GP follow-up was worrisome given paediatric asthma care guidelines recommended a review after a hospital admission or ED presentation as well as ongoing regular checks-ins.

The research stated only 39.2 per cent of GPs knew their patient had been readmitted to hospital for asthma, highlighting the need for hospitals to improve their communication. Additionally, only 12 per cent of GPs were confident managing children with poorly controlled asthma, indicating a need to provide easy access to specialist advice for more severe cases.  

Hospital readmission rates in Victoria have increased from one in three children within 12 months compared with one in four a decade ago. Asthma is a leading cause of chronic illness and unplanned hospital admissions for children.  

Murdoch Children’s Dr Katherine Chen said there were opportunities to improve childhood asthma care across the whole system including strengthening education around the importance of regular, proactive primary care visits, increasing access to GPs, addressing gaps in guideline practices for paediatric asthma management and improving communication between hospitals and GPs.

“The findings highlight the importance of improving accessibility, consistency in care and streamlining communications,” she said. Each hospital admission should prompt a holistic evaluation of the child’s asthma management to prevent future readmissions. Making these improvements will require ongoing infrastructure and workforce planning, funding and better education.”

Read more on the study.