Improving childhood asthma management in Melbourne's inner west

The asthma care system involves a wide range of stakeholders such as:

• GPs
• local hospitals
• schools
• pharmacies
• sporting and community bodies.

Consistent, joined-up support and care are required to help families successfully navigate the asthma care system in order to receive the right care, at the right time from the right person. The ICAM program set out move the system towards this state.

Characteristics of our systems approach were:

• Investigating the underlying problems including listening to lived local experiences​
• Continuously involving stakeholders to ensure multiple-perspectives where understood
• Supporting deep collaboration and integration between six concurrent projects​
• Using a causal loop diagram to understand the interrelationships and identify impactful interventions​
• Co-developing multiple rapid interventions to nudge the whole system towards the desired state​
• Encouraging and fostering co-design and collaboration during implementation to forge sustainable relationships​
• Using storytelling as part of our evaluation

The funding:

• came as part of the Victorian Government's commitment to a range of initiatives totalling some $20 billion to improve air quality and liveability of Melbourne’s inner west
• aligned with the strategic objective of Victoria’s Air Quality Strategy to help vulnerable Victorians and support the broader community
• supported 6 projects to improve the local childhood asthma management system.

The context:

A needs analysis of the inner west revealed that, when seeking diagnosis or support manage a child’s asthma, families and carers can encounter a range of challenges and barriers that come with accessing and navigating the asthma care system.

The program involved the development and coordination of 6 separate projects led and delivered by key partner organisations involved in asthma care to:

• Improve the use and understanding of asthma action plans. This will help improve management of a child’s asthma, whether at home, school or in the health care setting. This project was led by Asthma Australia.
• Develop high-quality, streamlined clinical practice guidelines for childhood asthma. This project was led by the Royal Children’s Hospital, Melbourne.
• Develop and promote integrated care pathways. These will provide improved communication about patient care between health providers and support services. This project was led by Safer Care Victoria.
• Establish a community of practice that works together to improve childhood asthma. This project was also led by Safer Care Victoria and supported by the North Western Melbourne Primary Health Network.
• Design and deliver an education package to inner west asthma care providers. Content is locally tailored and based on best-practice asthma care. This project was led by National Asthma Council, Australia.
• Improve asthma self-management. This includes addressing barriers at the system level, and increasing skills and confidence at the individual level. This included the development of a children's picture book, video stories from local young people, in-language community information sessions and codesign of resources. This project was led by cohealth.

The development and production of these resources was funded by the Department of Health under the ICAM Program.

While the development of each resource was led by one of the funded partner organisations, the need for, and content of, all products and initiatives was determined in collaborative manner with input from the 5 ICAM partner organisations and with input from other relevant stakeholders, including:

• hospital staff
• local schools
• GP clinics
• pharmacists
• families of children with asthma
• young people with asthma.

Clinical practice guidelines

The Royal Children's Hospital have developed 2 clinical practice guidelines for:

• Preschool Asthma (1-5 years)
• Asthma in Primary School-aged Children (6-11 years)

These provide specific guidance on the management of asthma for clinicians, making managing children with asthma easier and more efficient and promoting consistent management across the health care system.

Lead organisation: Royal Children’s Hospital Melbourne.

Online training course

• Improving childhood asthma management in the inner west online training.

Participants learn how to:

• Identify the steps involved in the diagnosis of paediatric and adolescent asthma.
• Identify asthma triggers and those triggers specific to the inner west of Melbourne.
• Describe the management of asthma across the different ages in children and adolescents.
• Summarise the important information to be included in a Written Asthma Action Plan.
• Define the steps in managing acute asthma in primary care.

More about the course:

• This 1-hour interactive educational online course is aimed at general practitioners, nurses, pharmacists, and allied health care providers.
• It generates RACGP: 1 CPD Activity Point
• It is designed to meet the needs of health professionals living and working in Melbourne’s inner western suburbs.
• The program is available online on-demand.

Lead organisation: National Asthma Council Australia.

Community of Practice

Safer Care Victoria and North Western Melbourne Primary Health Network have combined efforts to invite expressions of interest for a Community of Practice for the inner west.

You can register your interest via email by providing your contact details to: education@nwmphn.org.au

Clinicians of all types providing care for children living with asthma from the inner western suburbs of Melbourne are invited to form a community of practice to discuss management and system issues and share lessons from their work.

Lead organisation and more information available from: Safer Care Victoria supported by North Western Melbourne Primary Health Network.

Quality improvement (QI) activities for GPs

• Increase the number of children with asthma who have a complete asthma action plan: Use this to increase the number of children with asthma who have a complete Asthma Action Plan (AAP).
• Increase the number of children with asthma who have had a 6-monthly asthma review: Use this to increase the number of children with asthma who have had a 6-monthly asthma review (moderate to severe asthma).

Lead organisation: North Western Melbourne Primary Health Network supported by Safer Care Victoria and Asthma Australia.

Printed material

• Childhood asthma management in Melbourne’s inner west

This booklet has been developed for healthcare providers. It provides an overview of asthma management resources and services in Melbourne’s inner west, including locally accessible support services for:

• referrals
• clinical management tools
• quality self-management tools for patients
• further education and training.

Lead organisation: Safer Care Victoria supported by North Western Melbourne Primary Health Network.

Community information sessions

• Asthma self-management for young children information sessions

Providing childhood asthma information and education to communities across the Inner West, these sessions teach parents and caregivers about asthma self-management for young children and support access to existing services.

Lead organisation: cohealth in partnership with The Water Well Project and cohealth Bi-Cultural Work Program.

Printed material

• ‘Minh’s Asthma story’ children’s story book

This bilingual storybook follows Minh’s family as they journey from first asthma symptoms, to diagnosis, to asthma self-management.

Codesigned with the Vietnamese-speaking women’s group in Brimbank, the story is bilingual in English and Vietnamese. Aimed at children aged 5-9 and their carers, the storybook is available at Local Government and Primary School Libraries.

Lead organisation: cohealth

• Childhood asthma support resources guide

Resources for children and young people, their parents and carers in Melbourne’s inner west. Discover the best apps, videos, publications, websites, services and translated resources. Designed to help you learn about and manage asthma in children and young people.

Lead organisation: Safer Care Victoria supported by North Western Melbourne Primary Health Network.

• Breathe Easy brochure

This brochure includes information and services in Melbourne’s inner west that can help families to understand and manage childhood asthma. Breathe Easy is available in Arabic, English, Simplified Chinese, and Vietnamese.

Lead organisation: cohealth

• Community Asthma Program poster

This poster promotes cohealth Community Asthma Program. They provide information about how to access the program and the type of support available.

Lead organisation: cohealth

Online videos

• Asthma Storyworks – youth videos

This series of seven Asthma youth videos produced for social media (from 29 sec – 2:34) promote asthma self-management among young people through video storytelling. Over eight weeks, young people with asthma participated in video storytelling workshops and were mentored to produce their own videos promoting asthma self-management in young people.

Lead organisation: cohealth with Community Health Advancement and Student Engagement (CHASE)

• Asthma in preschool children video for parents and carers

The video explains what causes wheezing in preschool children, how the diagnosis of asthma can be made in this age group, and how to care for young children with asthma, sometimes called ‘wheeze’.

Lead organisation: Royal Children’s Hospital Melbourne

• Asthma Action Plans animation

Asthma Action Plans animation (2 mins) is designed for patients (and their carers) with asthma.

It explores the purpose of an asthma action plan, how to get one, understanding your plan and what to do when symptoms get worse or in an emergency. The video also has translated versions (Arabic, Chinese and Vietnamese).

Lead organisation: Asthma Australia

Online training

• Childhood Asthma Guide for Inner West Melbourne (schools and sports clubs) 

This free course is available to asthma care providers such as school staff and sports club staff including leadership staff, teachers, relievers, coaches, officials, trainers, and volunteers. This 1 hour online interactive session that aims to identify and manage asthma in children and adolescents 5-19 years old within a school or sports settings.

Lead organisation: National Asthma Council Australia.

ICAM Partner web pages

Several partner websites have shared their ICAM resources including:

• Cohealth ICAM page: view, download or order resources developed by cohealth for the ICAM program.
• Asthma Australia ICAM page: learn more about Asthma Australia’s involvement in ICAM.
• National Asthma Council Australia ICAM training packages page: learn more about National Asthma Council Australia’s involvement in ICAM.
• Safer Care Victoria ICAM page - find out more about Safer Care Victoria’s involvement in ICAM, including strengthening integrated care pathways.

Case studies and stories

Read a case study or listen to a story from the ICAM program:

• Three consumers shared their stories of interacting with the childhood asthma care system. You can watch and read them by selecting the ‘stories from consumers’ dropdown on the cohealth ICAM page.
• More case studies and stories - coming soon.