Children living in inner west communities have elevated rates of asthma-related emergency department presentations compared to metropolitan Melbourne, cementing childhood asthma as an important health priority in this area.
The Victorian Department of Health developed the Improving Childhood Asthma Management (ICAM) project in the inner west of Melbourne to remove barriers and ease the burden of diagnosing and managing asthma for children and their carers.
As part of this work North Western Melbourne Primary Health Network (NWMPHN) has been working with Safer Care Victoria (SCV) to establish and manage a community of practice that promotes cross-sector collaboration and communication. It aims to build relationships, knowledge, trust and efficiencies across the local asthma care system. As this structure matures it has a potential “system stewardship” role whereby local stakeholders, vested in asthma care, can work collaboratively to identify areas for attention and to drive ongoing local improvements.
Here, Dr Kirsty Tamis from Forsyth Park Medical Centre in Truganina outlines the progress so far.
In September 2022 I was asked to help co-facilitate a community of practice which would focus on improving asthma outcomes in the paediatric population of Melbourne’s western suburbs.
Data shows that children in this area have poorer asthma outcomes and higher risks of admission to hospital than in other areas of the city.
Working with Dr Katherine Chen, clinical lead of the Royal Children’s Hospital (RCH) short stay unit, NWMPHN and Safer Care Victoria (SCV) we set out monthly topics that would attract a multidisciplinary group of professionals to discuss working practices, clinical guidelines, resources and personal experiences of asthma care. The aim was to increase professional knowledge of how asthma care is being delivered and work on opportunities to improve that care.
There have been four community of practice sessions run so far:
October 2022 – Childhood asthma management
October saw us discuss 2022 Global Initiative for Asthma (GINA) guidelines. These move focus away from traditional preventer/reliever asthma care towards Symbicort Maintenance and Reliever Therapy (SMART) for patients over 12. Lively discussion ensued from our community asthma nursing teams, pharmacists, paediatricians, ED physicians and GPs attending, which saw us share experiences and come up with some actionable outcomes on how to provide more continuity between them.
Changes to discharge planning at the RCH were implemented. Following the meeting, I was contacted by local community asthma nurses to further discuss ways to communicate and further multidisciplinary team care in our community.
Resources:
- Global Initiative for Asthma Guidelines 2022
- Royal Children’s Hospital – management of acute asthma
- National Asthma Council – SMART action plans
- HealthPathways Melbourne – Acuta asthma in children
- Kiss My Asthma app
November 2022 – Seasonal triggers
November focused on the timely topic on seasonal asthma, thunderstorm asthma, and allergies. We had two fantastic speakers and again a great representation from the local asthma multidisciplinary team in primary and secondary care. Resource sharing including the Vic Emergency App that includes an ability to notify of upcoming thunderstorm asthma risk, when where and how to refer for allergy testing and desensitisation, and screening methods to ensure seasonal allergies are controlled in asthmatic patients. Discussion centred around becoming confident and consistent with messaging about how important allergy control is in asthma prevention.
Resources:
- Royal Children’s Hospital – Allergic rhinitis hay fever
- Asthma Australia thunderstorm asthma
- Auspollen pollen forecast website
- Vic Emergency app – provides an update on thunderstorm asthma events in your area
- Victorian Department of Health Epidemic thunderstorm asthma risk forecast
December 2022 – Community asthma services
December saw the last topic of the year with speakers from the community asthma program run by cohealth and Asthma Australia discussing their 1800 ASTHMA resource. The community asthma nurses at cohealth run an incredible service in the western suburbs, through which children can access free, hour long asthma reviews and education in the clinic or their home. The nurses provide education to schools and preschools and can be included as providers on care plans.
1800 ASTHMA provides free, instant access service to asthma educators. It operates Monday to Friday between 9am and 5pm. Patients can self-refer. The service can be used as a tool post consult to follow up on education and clarify management plans. Primary and secondary care attendees discussed how to better integrate these services and shared their experiences in time-limited environments of delivery asthma education.
Resources:
February 2023 – Preschool wheeze
We’ve started the year strongly with February’s session focusing on the new preschool wheeze guidelines developed by Dr Shivanthan Shanthikumar, respiratory lead at RCH. The discussion covered diagnosing and undiagnosing asthma in the under-fives, when to use and when not to use steroids and antibiotics and the age-old question: is that crackle viral or bacterial?
Resources:
- Preschool wheeze guidelines are currently being updated by RCH. They will be added to HealthPathways as soon as the process is complete
This experience has been great for me in terms of knowledge and resources. However, the greatest outcome has been in the ethos of community of practice. One of the biggest obstacles to good patient care is lack of continuity, communication and resource-sharing between services. How often in your working day do you wish you could just have all the stakeholders in a patient’s care present at one time, discussing how we can work together to make the system better, right now? It has been an open, informal and supportive space to discuss more challenging experiences, and for all health care providers to question each other on our ways of practice. If you can make it along to one of the future sessions, we’d love to see you there!
Future community of practice sessions
Registration for the next two community of practice sessions is open on the NWMPHN website. This series will run until June 2023.
- 8 March 2023: Improving childhood asthma management community of practice – session 5: Asthma in 5–12 year olds
- 12 April 2023: Improving childhood asthma management community of practice – session 6: Difficult to control asthma – the role of rarely used puffers, biologics, and referral pathways
