Asthma Crisis in Paediatrics: Impact of a Care Pathway in Primary and Hospital Care

Status: Recruiting
Location: See location...
Intervention Type: Behavioral
Study Type: Interventional
Study Phase: Not Applicable
SUMMARY

This study aims to evaluate the effect of the implementation of the new Asthma Integrated Care Pathway in the Basque Healthcare Service for the improvement of care for children with asthma attacks and the reduction of variability between professionals and care settings in this care practice. Asthma is the most common chronic disease in children and has a major impact on people's quality of life. The Asthma Integrated Care Pathway is a structured multidisciplinary care plan that details the essential steps in the care of patients with mild-moderate asthma attacks and the coordinated practice of the agents involved as dictated by the evidence. This pathway will include quality indicators of compliance with diagnostic criteria, assessment of severity and prescription of drugs, as well as the experience of families and professionals, which have been collected in meetings designed for this purpose. The study consists in a mixed methods implementation trial with two phases: 1. Phase I: a quantitative evaluation will be carried out to assess implementation outcomes at the professional level through a pretest-posttest quasi-experimental study with paired control group, with a ratio of 1:2. The primary outcome variable will be the overall percentage of bronchodilator treatment with a spacer chamber in children diagnosed with mild-moderate asthma attacks. We will also include as outcomes to be measured the registration rate of the Pulmonary Score, the recording rate of the assessment of persistent asthma symptoms, and the rate of initiation of background treatment in children with persistent asthma symptoms. These variables will be analysed using differences in pre- and post-intervention outcome measures between the intervention and control groups. 2. Phase II: a qualitative evaluation will be carried out through a structured process with discussion groups focused on the identification of the main barriers and facilitators for the provision of recommended clinical practice related to asthmatic crisis in mild-moderate cases established by the Asthma Integrated Care Pathway. A purposive sample of paediatricians stratified by level of care and service organisations will be recruited to ensure that all views are represented in the discussion groups. The structured script will be designed with questions to explore each of the domains of the Theoretical Domains Framework (TDF). The study will be carried out mainly in two integrated healthcare organizations (IHO), which are made up of two primary care areas and the paediatric reference hospital emergency department of both areas, as well as the hospitalisation, intensive care and paediatric pneumology departments of said hospital, to extend in the future the Asthma Integrated Care Pathway to the rest of the Basque Health Service IHOs.

Eligibility
Participation Requirements
Sex: All
Healthy Volunteers: f
View:

⁃ Eligibility for professionals:

• Primary Care paediatricians and nurses

• Paediatricians and nurses in the Paediatric Emergency Department

• Paediatricians and nurses on the inpatient ward

• Paediatric Intensive Care paediatricians and nurses

• Paediatric Pneumology paediatricians and nurses

⁃ Eligibility for patients:

⁃ Patients between 2 and 14 years,that have being attended between the 7 May 2023 and the 7 May 2025, and with an acute episode of asthma, defined as:

• an episode of wheezing and a previous diagnosis of asthma or with a previous episode of wheezing

• a first episode in a child older than 2 years with a personal/family history of atopy and/or with an objective response to bronchodilators as assessed by the Pulmonary Score

Locations
Other Locations
Spain
Primary Care Research Unit of Bizkaia
RECRUITING
Barakaldo
Contact Information
Primary
Alvaro Sanchez Perez
ALVARO.SANCHEZPEREZ@osakidetza.eus
(+34)946006673
Time Frame
Start Date: 2023-05-07
Estimated Completion Date: 2026-05-07
Participants
Target number of participants: 249
Treatments
Experimental: Asthma Care Pathway group
All the primary care and hospital pediatricians of the two Integrated Hospital Organizations (IHO) (Barakaldo-Sestao and Ezkerraldea-Enkarterri-Cruces) where the care pathway will be implemented. 83 participants in total.
No_intervention: Control
Primary care and hospital pediatricians of other IHOs where the care pathway is not implemented, but with similar characteristics to those in the experimental group, and with a proportion of 1:2. 166 participants in total.
Related Therapeutic Areas
Sponsors
Leads: Basque Health Service
Collaborators: Health Department of the Basque Government

This content was sourced from clinicaltrials.gov

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