1800 278 462
A virtual asthma care model to reduce unscheduled hospital presentations
 |
Dr Ryan Mackle
Sydney Children’s Hospital Dr Ryan Mackle is currently a paediatric respiratory fellow at the Sydney Childrens’ Hospitals Network and a member of the Royal Australasian College of Physicians (RACP). He has extensive experience in childhood asthma management and paediatric respiratory medicine both in Australia and the UK. Ryan is an advocate for improving the health and wellbeing of children. He started his PhD at the University of New South Wales in 2022. PhD Status: In progress Grant Type: PhD scholarship |
Asthma Australia is proud to support the careers of our future asthma researchers
This includes Dr Ryan Mackle, who is currently completing his PhD project.
“This Asthma Australia Scholarship gives me the invaluable opportunity to embark on research early in my paediatric respiratory career. I hope that through this PhD I can continue to make an ongoing impact in the care and management of childhood asthma.” – Dr Ryan Mackle
Ryan’s project trialled a multicomponent asthma model of care for children living in rural NSW who present to the emergency department for their asthma. It aimed to connect children and their families to the right care, regardless of where they live.
About the research
Ryan and the research team evaluated a co-developed, multicomponent asthma model of care in rural hospitals in NSW. Children aged 5-12 years old with asthma who go to the emergency department because of their asthma were invited to take part in the study.
Children were provided a suite of interventions including an asthma discharge resource pack and SMS reminders encouraging GP follow-up and access to online educational resources. Children with poorly controlled asthma upon study enrolment were additionally offered a virtual home visit with a local paediatric nurse within 3 months of hospital discharge. These virtual consultations enabled children and their parents to speak about their asthma symptoms and control, triggers in the home, and any concerns the families have.
“This funding of research into rural and remote communities is vital to improve equitable access to healthcare for all children with asthma.” – Dr Ryan Mackle
The researchers aimed to show that this model of care improves family’s knowledge of asthma, empowered them to self-manage their asthma, and led to better adherence to asthma medications.
Why was funding this research important?
In New South Wales there are more than 10,000 presentations to emergency departments for children with asthma every year. Each presentation can create significant stress for the child and families. Many presentations can also be prevented through the right education and care of children and families.
However, paediatric asthma specialists are only accessible in metropolitan hospitals and vulnerable rural children may be further burdened as a result.
This project aimed to address this gap and build on previous research to provide a patient-centred approach that allows shared decision making and planning of asthma care remotely.
Research Outcomes
The Asthma Care from Home project enrolled 188 children with asthma, and their families, from regional NSW areas including Illawarra Shoalhaven, Northern, Southern and Western NSW. The project’s model of care resulted in a 69% decrease in emergency department visits and 81% decrease in hospital stays compared to the 12 months before enrolment. There were also significant improvements in children’s asthma symptom control and quality of life.
Parents appreciated getting asthma information and support specifically tailored to their child, which helped them feel more confident managing asthma at home. Many families shared that before the project, they struggled to access healthcare in their local communities and had few opportunities to get quality asthma care. Both parents and health professionals highly valued the model’s virtual home visits, delivered by upskilled local nurses, which allowed children and parents to get the personalised help they need after leaving hospital. These virtual consultations also helped bridge the gap between hospital and community services, so children could be supported shortly after hospital discharge. Rural health professionals also valued how the project improved teamwork and communication between different health services and made asthma care more consistent. Nurses were identified as essential to making the asthma care model work.
The Asthma Care from Home project’s sustained improvements demonstrate why our asthma care model is needed in rural areas. Both families and health professionals want to continue this asthma model in their communities. Greater use of digital tools and integrating the program into nurses’ everyday work will help make it sustainable long-term.
Related publications
Mackle R, Crespo Gonzalez C, Chan M, Hodgins M, Hu N, Angell B, Owens L, Fletcher J, McCrossin T, Piper S, Doyle AK, Woolfenden S, Gould B, Ward F, Lingam R, Jaffe A, Gray M, Homaira N; Asthma Care from Home Collaborative Group. Asthma Care from Home: Study protocol for an effectiveness-implementation evaluation of a virtually enabled asthma care initiative in children in rural NSW. PLoS One. 2024 Jun 13;19(6):e0304711. doi: 10.1371/journal.pone.0304711.
Mackle R, Crespo-Gonzalez C, Gray M, Chan M, Hodgins M, Hu N, Angell B, Campbell N, Owens L, Fletcher J, McCrossin T, Piper S, Du H, Haggie S, Doyle AK, Woolfenden S, Gould B, Ward F, Lingam R, Homaira N, Jaffe A. Implementing enhanced paediatric asthma care in rural Australia: Qualitative insights from healthcare professionals. Respiratory Medicine 2025;249:108444. https://doi.org/10.1016/j.rmed.2025.108444
de Groot A, Mackle R, Gray M, Chan M, Hodgins M, Hu N, Angell N, Campbell N, Owens L, Fletcher J, McCrossin T, Piper S, Du H, Haggie S, Doyle, Auntie K, Woolfenden S, Gould B, Ward F, Jaffe A, Homaira N, Lingam R, Crespo-Gonzalez C. Understanding how personalized pediatric asthma information and support addresses rural families’ unmet needs. Journal of Rural Health (under review)
