Andrew J Collaro1, Anne B Chang2, Julie M Marchant3, Leanne T Rodwell4, Ian B Masters5, Mark D Chatfield6, Margaret S McElrea5. 1. Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Centre for Children's Health Research, Queensland University of Technology, QLD, Australia. Electronic address: andrew.collaro@health.qld.gov.au. 2. Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Centre for Children's Health Research, Queensland University of Technology, QLD, Australia; Child Health Division, Menzies School of Health Research, NT, Australia; Indigenous Respiratory Outreach Care, The Prince Charles Hospital, QLD, Australia. 3. Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Centre for Children's Health Research, Queensland University of Technology, QLD, Australia. 4. Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Indigenous Respiratory Outreach Care, The Prince Charles Hospital, QLD, Australia. 5. Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Centre for Children's Health Research, Queensland University of Technology, QLD, Australia; Indigenous Respiratory Outreach Care, The Prince Charles Hospital, QLD, Australia. 6. Child Health Division, Menzies School of Health Research, NT, Australia; Faculty of Medicine, The University of Queensland, QLD, Australia.
Abstract
BACKGROUND: Inequitable access to quality health care contributes to the known poorer outcomes of people living in regional/remote areas (compared with urban-based), especially for First Nations people. Integration of specialist outreach services within primary care is one strategy that can reduce the inequity when modeled to the needs and available resources of target communities. RESEARCH QUESTION: To evaluate whether respiratory outreach clinics in regional and remote Queensland are as effective as tertiary respiratory services at improving the lung function of children. STUDY DESIGN AND METHODS: From existing databases, we obtained spirometry data of children (aged 3-18 years) seen at Indigenous-focused outreach clinics in regional and remote Queensland and Brisbane-based pediatric tertiary hospitals over the same contemporary period (October 2010 to July 2019). We compared the change in spirometry z scores (Δz) at follow-up for both groups of children. RESULTS: Lung function significantly improved in both groups: Tertiary hospital (n = 2,249; ΔzFEV1 = 0.22, 95% CI, 0.17 to 0.27; ΔzFVC = 0.23, 95% CI, 0.18 to 0.28); outreach (n = 252; ΔzFEV1 = 0.35, 95% CI, 0.22 to 0.48; ΔzFVC = 0.36, 95% CI, 0.23 to 0.50). No significant intergroup differences were found in ΔzFEV1 (0.13; 95%CI, -0.02 to 0.28; P = .10) or ΔzFVC (0.14; 95% CI, -0.02 to 0.29; P = .08) improvement from baseline. In both groups, the proportion of children with zFEV1 > 0 at follow-up (hospital = 31.7%; outreach = 46.8%) significantly increased (hospital P = .001; outreach P = .009) from baseline (hospital = 27.2%; outreach = 35.3%). Numbers of children with zFEV1 > 0 significantly increased for asthma and bronchiectasis outreach subgroups, and for children with asthma in the hospital-based group. INTERPRETATION: Comparable significant lung function improvement of children was seen in Indigenous-focused outreach remote/regional clinics and paediatric tertiary hospitals. This suggests that effective clinical care is achievable within the outreach setting.
BACKGROUND: Inequitable access to quality health care contributes to the known poorer outcomes of people living in regional/remote areas (compared with urban-based), especially for First Nations people. Integration of specialist outreach services within primary care is one strategy that can reduce the inequity when modeled to the needs and available resources of target communities. RESEARCH QUESTION: To evaluate whether respiratory outreach clinics in regional and remote Queensland are as effective as tertiary respiratory services at improving the lung function of children. STUDY DESIGN AND METHODS: From existing databases, we obtained spirometry data of children (aged 3-18 years) seen at Indigenous-focused outreach clinics in regional and remote Queensland and Brisbane-based pediatric tertiary hospitals over the same contemporary period (October 2010 to July 2019). We compared the change in spirometry z scores (Δz) at follow-up for both groups of children. RESULTS: Lung function significantly improved in both groups: Tertiary hospital (n = 2,249; ΔzFEV1 = 0.22, 95% CI, 0.17 to 0.27; ΔzFVC = 0.23, 95% CI, 0.18 to 0.28); outreach (n = 252; ΔzFEV1 = 0.35, 95% CI, 0.22 to 0.48; ΔzFVC = 0.36, 95% CI, 0.23 to 0.50). No significant intergroup differences were found in ΔzFEV1 (0.13; 95%CI, -0.02 to 0.28; P = .10) or ΔzFVC (0.14; 95% CI, -0.02 to 0.29; P = .08) improvement from baseline. In both groups, the proportion of children with zFEV1 > 0 at follow-up (hospital = 31.7%; outreach = 46.8%) significantly increased (hospital P = .001; outreach P = .009) from baseline (hospital = 27.2%; outreach = 35.3%). Numbers of children with zFEV1 > 0 significantly increased for asthma and bronchiectasis outreach subgroups, and for children with asthma in the hospital-based group. INTERPRETATION: Comparable significant lung function improvement of children was seen in Indigenous-focused outreach remote/regional clinics and paediatric tertiary hospitals. This suggests that effective clinical care is achievable within the outreach setting.
Authors: Julie M Marchant; Anne B Chang; Kobi L Schutz; Lesley Versteegh; Anne Cook; Jack Roberts; Peter S Morris; Stephanie T Yerkovich; Gabrielle B McCallum Journal: BMJ Open Date: 2021-12-22 Impact factor: 2.692
Authors: Andrew J Collaro; Anne B Chang; Julie M Marchant; Mark D Chatfield; Annette Dent; Tamara Blake; Patsi Mawn; Kwun Fong; Margaret S McElrea Journal: Lancet Reg Health West Pac Date: 2021-07-05
Authors: Andrew J Collaro; Anne B Chang; Julie M Marchant; Mark D Chatfield; Annette Dent; Tamara Blake; Patsi Mawn; Kwun Fong; Margaret S McElrea Journal: Lung Date: 2021-07-03 Impact factor: 2.584
Authors: Anne B Chang; Jeanette Boyd; Leanne Bell; Vikas Goyal; I Brent Masters; Zena Powell; Christine Wilson; Angela Zacharasiewicz; Efthymia Alexopoulou; Andrew Bush; James D Chalmers; Rebecca Fortescue; Adam T Hill; Bulent Karadag; Fabio Midulla; Gabrielle B McCallum; Deborah Snijders; Woo-Jung Song; Thomy Tonia; Keith Grimwood; Ahmad Kantar Journal: ERJ Open Res Date: 2021-07-19