Virtual asthma care model to reduce unscheduled hospital presentations (Ryan Mackle)

Virtual asthma care model to reduce unscheduled hospital presentations (Ryan Mackle)

Implementation and evaluation of a comprehensive virtual asthma care model to reduce unscheduled hospital presentations in vulnerable children within NSW

Dr Ryan Mackle MB BCh BAO

Sydney Children’s Hospital

Dr Ryan Mackle is currently a paediatric trainee at the Sydney Children’s Hospital in Randwick 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 is due to commence his PhD at the University of New South Wales in 2022.

Project Status: In progress, beginning February 2022

Why was funding this research important?
It has been estimated that 10% of Australia children have a diagnosis of asthma. In NSW alone there are more than 10,000 paediatric ED presentations with flare-ups of asthma every year. Frequent hospital presentations with acute asthma are an indication of poorly controlled disease which is a concern because of the longer-term impact of asthma on children. Additionally, as access to paediatric asthma specialists is limited to metropolitan tertiary level hospitals, vulnerable rural children may be further burdened as a result. This is evidenced with continued disparities in the asthma outcomes between people living in metropolitan and rural/remote areas.

It has been long established that childhood hospital admissions can be significantly reduced if there is appropriate asthma education and involvement of parents and children in the establishment of a care plan, and this study aims to build on previous research collaborations to facilitate a remote patient-centred approach allowing shared decision making and planning of asthma care.

“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

What are the researchers doing?
This project proposes to facilitate patient centred care for children with asthma in rural settings using a range of familiar digital technologies such as the Web, Email, Zoom and Facetime in an integrated way to connect the patients and their families to acute, primary and community services remotely.

The virtual model of care will be tested within rurally based hospitals. All children aged 5-16 years presenting with at least 2 ED visits or at least 1 hospital admission for asthma in the previous 12 months will be flagged by local staff to a hospital-based care coordinator and investigating team. All consenting children will be followed up for 12 months.

Parents and families from the rural hospitals will be provided with access to a web-based database to log symptoms, medication use and peak respiratory flow, linking these entries with primary care providers, local asthma specialist nurse and paediatrician via email alerts on discharge. Changes in symptoms control will be flagged by the system for urgent review. Families will be provided with virtual home visits via digital technologies like skype, Microsoft Teams or Zoom with their local asthma specialist nurse on a 3 monthly basis and paediatrician on a 6 monthly basis to assess asthma symptoms control, home environmental triggers and to respond to parents/carers concern relating to their child’s asthma.

The proposed outcomes of this research include:

  1. Improved knowledge of paediatric asthma as a disease by children, parents, and carers
  2. Empowering of parents/carers and children to self-manage asthma
  3. Better adherence to asthma medication.

It is anticipated the virtual model of care could lead to up to a 60% reduction in unscheduled hospital visits for 5-16 years old’s in rural areas.

“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