National survey could lead to improvements in healthcare for children

A landmark national study on the standard of healthcare for children in Australia has found they receive care that is within clinical practice guideline recommendations 60 percent of the time, on average, for 17 common medical conditions.

The CareTrack Kids study, led by the Australian Institute of Health Innovation at Macquarie University, evaluated care for 6689 children under 16 years of age using 160,202 clinical indicator assessments, looking at how often care was given in accordance with clinical practice guideline recommendations.

The study – the largest of its kind ever conducted – is published in the Journal of the American Medical Association. Professor Adam Jaffe, Head of the UNSW School of Women's and Children's Health in the Faculty of Medicine, was one of the chief investigators.

There was substantial variation in adherence to guidelines by clinical condition: for example, there was almost 89 percent adherence on average for the management of autism, 54 percent in the management of fever, and 44 percent for tonsillitis.

In practice, this could mean that rather than complying with guidelines for tonsillitis, fever or upper respiratory tract infection, a clinician may treat a child with antibiotics instead, contrary to recommendations. Reduction in the unwarranted use of antibiotics is strongly supported by public health authorities.

For six conditions – four mental health conditions, diabetes and head injury – estimated adherence to guidelines was greater than 70 percent.

Asthma was another condition examined where overall compliance was not high, at 58 percent. Guidelines for the management of asthma recommend that each child receive a written action plan.

However, the study found that only 47 percent of children who were prescribed an asthma preventer were also provided with a plan, in contrast to the 92 percent of children who received a plan following hospitalisation due to an asthma flare-up.

"Improving the way we deliver care for a condition like asthma, the most common chronic disease in children, can make a real difference to our patients and reduce the burden on services," says Professor Jaffe, a respiratory paediatrician and Associate Director of Research for the Sydney Children's Hospitals Network.

"A written plan early on can mean the difference between a good level of control and hospitalisation," he says.

Professor Jeffrey Braithwaite, lead author of CareTrack Kids and Founding Director of the Australian Institute of Health Innovation at Macquarie University, says: "With the release of these results, we need to reflect on how we can improve the healthcare system. Clinicians want to do their best for all their patients and we need to modify the system to help them achieve this goal.

"We also recognise that guidelines should not be followed slavishly all the time. There are always exceptions, including that a family's preferences matter or that there are clinically relevant reasons for deviations.

"We suggest several improvements to the health system, including advancing the design of electronic medical records, to give clinicians ready access to real-time information. We also need to collect patient data in a structured way when the child is being treated in order to support the clinician's decision making and provide better information to their carers.

"There are always challenges. These results are as good as elsewhere in the world, but Australia can do even better.

"This study highlights which conditions need most attention and will drive concerted efforts to improve patient care," says Professor Braithwaite.

The study involved 139 healthcare provider sites: 85 GP clinics, 20 specialist practices and 34 hospitals across New South Wales, Queensland and South Australia. It examined care provided to children in 2012 and 2013.

The original CareTrack adults study, published in 2012, found Australian adults receive appropriate healthcare in 57 percent of consultations.