Culturally Appropriate Outreach Specialist Respiratory Medical Care Improves the Lung Function of Children in Regional and Remote Queensland

• Published in: Lung Vol. 198; no. 2; pp. 361 - 369
• Main Authors: Collaro, Andrew J., Chang, Anne B., Marchant, Julie M., Masters, Ian B., Rodwell, Leanne T., Takken, Allan J., McElrea, Margaret S.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2020; Springer
• Subjects: Bronchiectasis; Care and treatment; Demographic aspects; Diagnosis; Health aspects; Indigenous peoples; Medicine; Medicine & Public Health; Methods; Pediatric Pulmonary Disease; Pediatric research; Pneumology/Respiratory System; Spirometry; Queensland; Outreach; Respiratory; Lung function; Chronic respiratory disease; Paediatric spirometry
• ISSN: 0341-2040; 1432-1750
• DOI: 10.1007/s00408-020-00332-7

Background and Objectives Indigenous Respiratory Outreach Care (IROC) is a culturally appropriate specialist respiratory service established to deliver multidisciplinary respiratory care to regional and remote Queensland communities. Our objective was to evaluate the impact of an outreach specialist respiratory service on the spirometry of children attending IROC clinics, particularly Indigenous children with asthma and bronchiectasis. Methods Retrospective single-arm cohort study of 189 children who performed spirometry at twelve sites across regional and remote Queensland between October 2010 and December 2017. Each child’s baseline spirometry was compared to their best spirometry at follow-up visit occurring within (1) 12 months of their most recent visit with at least 12 months of specialist care and; (2) each year of their first 3 years of care. Results Forced expiratory volume in one second (FEV 1 ) and forced vital capacity (FVC) z -scores improved significantly across the whole group from baseline to follow-up (change in z -scores (Δ z ) of FEV 1  = 0.38, 95% CI 0.22, 0.53; Δ z FVC = 0.36, 95% CI 0.21, 0.51). In subgroup analyses, lung function significantly improved in Indigenous children ( n  = 141, ΔzFEV 1  = 0.37, 95% CI 0.17, 0.57; ΔzFVC = 0.36, 95% CI 0.17, 0.55) including those with asthma ( n  = 117, ΔzFEV 1  = 0.41, 95% CI 0.19, 0.64; ΔzFVC = 0.46, 95% CI 0.24, 0.68) and bronchiectasis ( n  = 38, ΔzFEV 1  = 0.33, 95% CI 0.07, 0.59; ΔzFVC = 0.26, 95% CI − 0.03, 0.53). Significant improvements in FEV 1 and FVC were observed within the first and second year of follow-up for Indigenous children, but not for non-Indigenous children. Conclusion The IROC model of care in regional and remote settings leads to significant lung function improvement in Indigenous children with asthma and bronchiectasis.