6 th may 2014 dr. james paton university of glasgow, clinical audit lead, rcpch nrad and children...
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6th May 2014
Dr. James PatonUniversity of Glasgow, Clinical Audit Lead, RCPCH
NRAD and ChildrenWhat the Report Means for Paediatric Care
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28 Children and Young People Died of Asthma
Age Group<10 yrs 10 (5%)10 – 19 yrs 18 (9%)20 – 44yrs 33 (17%)
45 – 64yrs 50 (26%)
65 – 74yrs 35 (18%)
75 + 47 (24%)
Age 4 – 19 yrs
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Many Children Died Before Reaching Hospital
8/10 (80%) children <10 yrs
13/18 (72%) children 10-19 yrs
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Even Those With Mild/ Moderate Asthma Were At Risk
Age GroupAsthma Severity <10 years 10 - 19yrsMild 0 0% 1 6%Moderate 3 30% 8 44%Severe 6 60% 7 39%Not Known 1 10% 2 11%Total 10 100% 18 100%
12/28 (42%) of children who died were thought to have mild / moderate asthma
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How Did the Children Die?
“Asthma Attacks”Only 4 / 28 (14%) children had a record ofbeing provided with an Asthma Action Plan
-How to spot when symptoms are getting worse-What to do when symptoms worsen-What to do in an emergency-When to call for emergency help
Targeting Lung Attacks Fitzgerald Thorax 2011;66: 365-66
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Avoidable Factors – Families & Environment
Factors Under 10yrs 10 - 19yrsOne or More Avoidable Factors 9 (90%) 17 (94%)Poor Adherence to Medical Advice 9 (90%) 13 (72%)- Failure to Take Appropriate
Medications4 (40%) 13 (72%)
Psychosocial factors 3 (30%) 4 (22%)Passive smoke exposure 3 (30%) 7 (39%)
Allergy - Animals - Food allergy - Seasonal
2 (20%)0 (0%)0 (0%)
2 (20%)
7 (39%)2 (11%) 2 (11%) 6 (33%)
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Adherence Matters!
• ICS Adherence >80% was associated with better asthma control
• Children with persistent mild symptoms had lower ICS adherence rates (p = .028)
ERJ 2014; 43: 783-91
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Daily Hospital Admissions for Asthma among Children between 2000 and 2009 in Scotland
Mackay et al N Engl J Med 2010; 363:1139-1145
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Avoidable Factors – Ongoing Medical Care/SupervisionFactors <10yrs
N (%)10 - 19yrs
N (%)1ry 2ry 1ry 2ry
One or More Avoidable Factors
8 (80) 4 (57) 16 (89) 4 (44)
- Did Not Check Inhaler Technique
3 (30) 2 (29) 2 (11) 2 (22)
- Did Not Identify Triggers 0 (0) 1 (14) 6 (33) 2 (22)
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Asthma Deaths and Time of Year
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Quality of Care – Panel ConclusionsConclusion All ages
(195)0-19(28)
Chronic Management - Adequate 56 (29%) 2 (7%)
Previous Attack Management- Adequate 69 (35%) 8 (29%)*
Final Attack Management- Adequate 66 (34%) 13 (46%)*
Overall Standard of Asthma Care- Good practice 31 (16%) 1 (4%)
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Trends in Childhood Asthma Deaths Have Been Downwards
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But Children with Asthma Are Still Dying
2012 – 17 CF deaths in children <20 yrs1
2012 – 28 Asthma deaths in children <20yrs
1UK Cystic Fibrosis Registry Annual data report 2012
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What Does the Report Mean for Paediatric Care?1. Always remember – children die of asthma – “Asthma
Attacks” can kill2. Everyone should have an asthma action plan3. Good adherence can be achieved, and does matter4. Passive smoking is bad for children with asthma5. Do not forget psychosocial factors & asthma triggers6. Meticulous attention to asthma guidelines will save
lives
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Expertise No.
Paediatricians (general, respiratory, allergy, intensive care and emergency care)
21
Adult physicians (general, respiratory, allergy, intensive care and emergency
67
General Practitioners 34
Pharmacists 2
Primary care nurses (specialist asthma and respiratory) 25
Secondary care nurses (consultants, paediatric nurses, specialist adult and paediatric asthma and respiratory nurses )
24
Clinical Lecturers 1
Total 174
NRAD Confidential Enquiry Panels
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Coding Accuracy - Panel vs Coding