Recognition and management of chronic wet cough in Aboriginal children: a knowledge translation approach

Abstract

Background: Chronic wet cough in children is the hallmark symptom of protracted bacterial bronchitis (PBB) and if left untreated can lead to bronchiectasis. Bronchiectasis is prevalent in Indigenous populations, but diagnosis is often delayed due to under-recognition of chronic wet cough. Our aim was to use knowledge translation (KT) methods to improve recognition and management of chronic wet cough. Methods: A mixed-methods, KT study (Feb 2017-Aug 2019) in a large remote town and Aboriginal medical service, which included: Culturally appropriate knowledge dissemination to facilitate family health seeking for chronic wet cough in children (including advertising and community presentations). An implementation strategy to facilitate correct diagnosis and management of PBB by clinicians (including training; information flip chart; updated, easy to access guidelines and systems to facilitate patient follow-up). Results: A 184% increase in health seeking for chronic wet cough occurred post KT (pre=8/630 (1·3%), post=23/636 children (3·6%), p=0·007). Clinician proficiency in management of chronic wet cough also improved significantly following KT, reflected by (i) improved clinician assessment of cough quality (p=0·026), duration (p=0.001) and appropriate antibiotic prescription (p Conclusion: Health seeking for Indigenous children with chronic wet cough can be facilitated through provision of culturally appropriate health information. Clinician proficiency in the management of chronic wet cough can be improved with KT leading to better parent-proxy QoL.