National study finds 60% adherence to clinical guidelines
A landmark national study led by the Australian Institute of Health Innovation at Macquarie University on the standard of healthcare for children in Australia has found children receive care in-line with clinical practice guideline recommendations on average 60 percent (59.8%) of the time for 17 common medical conditions.
The CareTrack Kids study published today in the Journal of the American Medical Association evaluated care for 6,689 children under 16 years of age, and involved 139 healthcare providers across New South Wales, Queensland and South Australia. The study is the largest of its kind ever conducted.
Two chief investigators of the CareTrack Kids study and authors of this publication are Sydney Children’s Hospitals Network’s Director of Research, Professor Chris Cowell and Associate Director of Research, Professor Adam Jaffe, Head of the School of Women’s and Children’s Health at UNSW.
Professor Les White AM, former Executive Director of Sydney Children’s Hospital and Chief Paediatrician of New South Wales is also a chief investigator and author of the study.
Another of the authors from Sydney Children’s Hospitals Network is Dr Sarah Dalton, Paediatric Emergency Physician at The Children’s Hospital at Westmead and President of the Royal Australasian College of Physicians’ Paediatrics and Child Health Division, who is also a Clinical Champion of CareTrack Kids.
The study looked at how often care was given in-line with clinical practice guideline recommendations, and found that there was substantial variation in adherence to these guidelines depending on the clinical condition.
For example, on average, there was 89% adherence for the management of autism, but 44% for tonsillitis. In practice, this could mean that rather complying with guidelines for tonsillitis, a clinician may treat a child with antibiotics instead, contrary to recommendations.
Asthma was another condition examined where overall compliance was not high, at 58%. Guidelines for the management of asthma recommend that each child receive a written action plan. However, this study found that only 47% of children who were prescribed an asthma preventer were also provided with a plan, in contrast to the 92% of children who received a plan following hospitalisation due to an asthma flare-up.
“Improving the way we deliver care for a condition like asthma, the most common chronic disease in children, can make a real difference to our patients and reduce the burden on services. A written plan early on can mean the difference between a good level of control and hospitalisation” said Professor Adam Jaffe, respiratory paediatrician.
For diabetes, head injury, ADHD, anxiety, autism spectrum disorder and depression, there was an estimated adherence to guidelines greater than 70%. A health system that delivers a higher overall adherence rate, up to around 90%, would most of the time lead to better outcomes for patients and more effective use of resources.
The original CareTrack Australia study in adults was published in 2012 found that Australian adults receive appropriate healthcare in 57% of consultations for 22 conditions.
“With the release of these results, we need to reflect on how we can improve the healthcare system. Clinicians want to do their best for all their patients and we need to modify the system to help them achieve this goal,” said Professor Jeffrey Braithwaite, lead author of CareTrack Kids and Founding Director of the Australian Institute of Health Innovation at Macquarie University.
“We also recognise that guidelines should not be followed slavishly all the time. There are always exceptions. We suggest several improvements to the health system, including advancing the design of electronic medical records, to give clinicians ready access to real-time information.”
“This study highlights which conditions need most attention and will drive concerted efforts to improve patient care,” concluded Professor Braithwaite.