Regular GP visits best for asthma

New Australian research has shown that frequent GP visits improve health outcomes for children with asthma, yet these visits are often irregular and inconsistent leading to an increase in hospital readmissions.

The two studies, led by Murdoch Children’s Research Institute, highlighted the gaps and opportunities across the primary care network for children affected by asthma to ensure services remain accessible in the wake of GP shortages and a decline in bulk billing services.

Their findings show that only one in five participants visited their regular GP on more than 60% of occasions and just 36% saw their GP within seven days of being discharged from hospital following an asthma attack – yet frequent GP visits were associated with reduced emergency presentations, hospital readmissions and improved asthma outcomes.

The median number of GP consultations and unique GPs and clinics visited was 9, 5, and 4, respectively.

The researchers stated there were opportunities to improve asthma care across the entire system including better education around the importance of regular primary care visits, increasing access to GPs, addressing gaps in guideline adherence, and improving communication between hospitals and GPs.

The first study, Primary health care utilization and hospital readmission in children with asthma: a multi-site linked data cohort study, published 3 January 2023 in Taylor and Francis Online, was an Australian multi-site cohort study of 767 children aged 3–18 years admitted with asthma between 2017 and 2018.

The participants were followed up for at least 12 months with outcome and primary care exposure data obtained through linked administrative datasets and estimated the effect of primary care utilization through a modified Poisson regression adjusting for child age, asthma severity, socioeconomic status, and self-reported GP characteristics.

The second study, Exploring gaps and opportunities in primary care following an asthma hospital admission: a multisite mixed-methods study of three data sources, published 4 January 202 in The Archives of Disease in Childhood, involved 277 GPs and 767 caregivers of children aged 3-18 years who were admitted to one of three hospitals in Victoria between 2017 and 2018 with a clinical diagnosis of asthma.

Dr Katherine Chen, from Murdoch Children’s Research Institute and the Department of Paediatrics at the University of Melbourne, and her colleague, Ms Renee Jones from the Murdoch Children’s Research Institute and Melbourne University’s School of Population and Global Health, were involved with both studies.

Ms Jones said the studies showed that children with asthma were receiving fragmented treatment in the primary care network.

“Families often reported being unable to access primary care before presenting to a hospital for their child’s asthma, highlighting a potential missed opportunity for avoiding an admission and for continuity of treatment,” she said.

“On top of this, families noted there were unclear pathways to follow-up care, with a lack of coordination between hospitals and their local doctor.”

Ms Jones highlighted that 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% of GPs knew their patient had been readmitted to hospital for asthma, highlighting the need for hospitals to improve their communication,” Ms Jones said.

“Additionally, only 12% of GPs were confident managing children with poorly controlled asthma, indicating a need to provide easy access to specialist advice for more severe cases.”

Asthma is a leading cause of chronic illness and unplanned hospital admissions for children and hospital readmission rates in Victoria have increased to one in three children, from one in four, within the last 12 months.

Dr Chen noted that the findings highlight the importance of improving accessibility, consistency in care and streamlining communications.

“Each hospital admission should prompt a holistic evaluation of the child’s asthma management to prevent future readmissions and making these improvements will require ongoing infrastructure and workforce planning, funding, and better education,” she said.

Dr Chen acknowledged Australia was facing a shortage of GPs and an increase in the likelihood of clinical practices charging for paediatric appointments to cover rising costs.

“This raises concerns about equity of access to primary care as some families may not be able to receive regular care or obtain an appointment during an asthma attack due to cost or GP shortages in some regions,” she said.

“New models of care and funding potentially involving nurses and pharmacists to complement primary care could be considered to help improve the system.”