Asthma Care from Home: Study protocol for an effectiveness-implementation evaluation of a virtually enabled asthma care initiative in children in rural NSW

Ryan Mackle; Carmen Crespo Gonzalez; Mei Chan; Michael Hodgins; Nan Hu; Blake Angell; Louisa Owens; Jeffery Fletcher; Timothy McCrossin; Susie Piper; Aunty Kerrie Doyle; Sue Woolfenden; Bronwyn Gould; Flic Ward; Raghu Lingam; Adam Jaffe; Melinda Gray; Nusrat Homaira; Asthma Care from Home Collaborative Group

doi:10.1371/journal.pone.0304711

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. eCollection 2024.

Authors

Ryan Mackle^{1

2}, Carmen Crespo Gonzalez¹, Mei Chan¹, Michael Hodgins¹, Nan Hu¹, Blake Angell³, Louisa Owens^{1

2}, Jeffery Fletcher^{4

5}, Timothy McCrossin^{6

7}, Susie Piper⁸, Aunty Kerrie Doyle⁹, Sue Woolfenden^{1

10

11}, Bronwyn Gould¹², Flic Ward¹³, Raghu Lingam^{1

14}, Adam Jaffe^{1

2}, Melinda Gray², Nusrat Homaira^{1

2}; Asthma Care from Home Collaborative Group

Affiliations

¹ Discipline of Paediatrics and Child Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia.
² Respiratory Department, Sydney Children's Hospital Randwick, Sydney Children's Hospital Network, Sydney, NSW, Australia.
³ The George Institute for Global Health, UNSW Sydney, NSW, Sydney, Australia.
⁴ Department of Paediatrics, The Tweed Hospital, Northern NSW Local Health District, Tweed Heads, Australia.
⁵ School of Medicine, Griffth University, Gold Coast, QLD, Australia.
⁶ Department of Paediatrics, Bathurst Base Hospital, Western NSW Local Health District, Bathurst, NSW, Australia.
⁷ Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Sydney, NSW, Australia.
⁸ Department of Paediatrics, South East Regional Hospital, Southern NSW Local Health District, Bega, NSW, Australia.
⁹ Discipline of Indigenous Health, School of Medicine, Western Sydney University, Sydney, NSW, Australia.
¹⁰ Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
¹¹ Department of Community Paediatrics, Sydney Local Health District, Sydney, NSW, Australia.
¹² General Practice, Paddington, NSW, Australia.
¹³ Parent of Child with Asthma, Australia.
¹⁴ Department of Community Paediatrics, Sydney Children's Hospital Randwick, Sydney Children's Hospital Network, Sydney, NSW, Australia.

Abstract

Background: Asthma is the leading source of unscheduled hospitalisation in Australian children, with a high burden placed upon children, their parents/families, and the healthcare system. In Australia, there are widening disparities in paediatric asthma care including inequitable access to comprehensive ongoing and planned asthma care for children.

Methods: The Asthma Care from Home Project is a comprehensive virtually enabled asthma model of care that aims to a. supports families, communities and healthcare providers, b. flexible and locally acceptable, and c. allow for adoption of innovations such as digital technologies so that asthma care can be provided "from home", reduce potentially preventable asthma hospitalisation, and ensure satisfaction at a patient, family, and healthcare provider level. The model of care includes standardisation of discharge care through provision of an asthma discharge resource pack containing individual asthma action plan, follow-up letters for the child's general practitioner (GP) and school/child care, and access to online asthma educational sessions and resource; post-discharge care coordination through text message reminders for families for regular GP review, email correspondence with their child's GP and school/childcare; and virtual home visits to discuss home environmental triggers, provide personalised asthma education and respond to parental concerns relating to their child's asthma. This study is comprised of three components: 1) a quasi-experimental pre/post impact evaluation assessing the impact of the model on healthcare utilisation and asthma control measures; 2) a mixed-methods implementation evaluation to understand how and why our intervention was effective or ineffective in producing systems change; 3) an economic evaluation to assess the cost-effectiveness of the proposed model of care from a family and health services perspective.

Discussion: This study aims to improve access to asthma care for children in rural and remote areas. Implementation evaluation and economic evaluation will provide insights into the sustainability and scalability of the asthma model of care.

Copyright: © 2024 Mackle et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

MeSH terms

Adolescent
Asthma* / therapy
Child
Child, Preschool
Female
Humans
Male
New South Wales
Rural Population*
Telemedicine

Grants and funding

This project was funded by a grant from the NSW Health Translational Research Grants Scheme. The views expressed are those of the authors and not necessarily those of the partner organisation. RM is supported by PhD scholarships from the Australian government Research Training Program (RTP), Asthma Australia and the Zoe Kennedy Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.