Trends in hospital-based management of acute asthma from a teaching hospital in South Asia

Abstract

The aim of this study is to evaluate the hospital-based management of acute asthma in south Asia and to compare practices over a 10-year period. Adult patients (n = 102) admitted at a teaching hospital with acute asthma were studied. Documentation of precipitating factors, family history and physical signs were inadequate in more than half of patients. Pulse oximetry was documented in 95 (93%) patients, but peak flow monitoring was performed only in 50 (49%) patients. Ten-year trend showed deterioration in history and physical examination skills, under use of peak flow readings, and poor pre-discharge instructions. Some aspects of improved care included frequent use of pulse oximeter, preference of inhaled over systemic bronchodilators and increased use of systemic steroids. Significant deficiencies were identified in hospital-based management of acute asthma. Most aspects of asthma care continued to fall short of asthma guidelines.

Investigating discharge communication for chronic disease patients in three hospitals in India

“…[32,35] They are also consistent with other LMIC-based studies that, via patient reports and record evaluations, have evidenced a lack of in-depth information provision during discharge and/or poor levels of patient understanding regarding post-discharge care requirements. [27][28][29][30] The provision of deficient documented discharge information may be of particular concern for patient self-management, as global literature (predominantly from high-income countries) has indicated that individuals can struggle to absorb the verbal information provided by HCPs during healthcare consultations. [56] Further, whilst there is a dearth of empirical research on HCP attitudes towards discharge in India, our research on outpatients and qualitative data regarding inpatients from the same study areas in India indicates that a paucity of time, available HCPs, training and guidelines are likely to be notable contributors to the suboptimal communication evidenced in this study.…”

“…[25] Some single-site observational studies have evaluated discharge practices and found issues regarding deficient documentation, guidelines, standardised procedures and patient education. [26][27][28][29][30] In addition, a recent (2019) study from South Africa found inadequate discharge planning (a process which involves healthcare information transfer between HCPs and between HCPs and patients/carers to ensure coordination and continuity of care) to be a significant contributor to potentially avoidable causes of readmissions. [31] Across India, a handful of studies have found inconsistencies in the provision of discharge information via HCP and patient reports and discharge ticket evaluations.…”