Volume 31, Issue 1 pp. 97-104
International Emergency Medicine

Message in a bottle: How evidence-based medicine and a programme change model improved asthma management in a low-income emergency department in Papua New Guinea

Rebecca Heath

Corresponding Author

Rebecca Heath

Royal Hobart Hospital, Hobart, Tasmania, Australia

Correspondence: Dr Rebecca Heath, Emergency Department, Royal Hobart Hospital, 48 Liverpool Street, Hobart, TAS 7000, Australia. Email: [email protected]Search for more papers by this author
Paul Tomaszewski

Paul Tomaszewski

The University of New South Wales, Sydney, New South Wales, Australia

Paul Daniel and Company, Hobart, Tasmania, Australia

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Michael Kuri

Michael Kuri

Modilon Hospital, Madang, Papua New Guinea

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Vincent Atua

Vincent Atua

Modilon Hospital, Madang, Papua New Guinea

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Georgina Phillips

Georgina Phillips

St Vincent's Hospital, Melbourne, Victoria, Australia

Monash University, Melbourne, Victoria, Australia

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First published: 20 December 2018
Citations: 4
Rebecca Heath, MRChB, BSc, MRes, DipMtnMed, Emergency Registrar; Paul Tomaszewski, MHM, MPH, BAppSci (Hons), DipBus, Managing Director; Michael Kuri, MBBS, Emergency Registrar; Vincent Atua, MBBS, DipAnaes, PGCert Teaching, MMed EM, MHM, Medical Director; Georgina Phillips, MBBS, FACEM, Emergency Physician, PhD Scholar.

Abstract

Objective

To improve asthma care in a complex, low resource, developing country setting. This observational study was carried out in a challenging low-income real-life setting in the ED at Modilon Hospital, Papua New Guinea. The only government hospital in Madang Province, with 258 beds, it provides medical care to a population of nearly 700 000 people of whom 40% live on less than US$1.25/day.

Methods

An asthma management analysis questionnaire followed by action research, with a four-step programme change model (exposure, adoption, implementation and practice), were used to develop and implement new department asthma guidelines. Staff perceptions were gathered via discussion groups and questionnaire.

Results

Asthma management initially involved frequent antibiotics, intravenous steroids, multiple short acting bronchodilators (oral, inhaled and nebulised) and limited oral steroids. No spacers, preventative inhaled steroid therapy or asthma action plans were used. On review after new guideline implementation staff felt antibiotic dispensing and concurrent use of multiple short acting oral bronchodilators decreased and spacer, preventer therapy and action plan use increased.

Conclusion

This project highlights the difficulties experienced with change management, both in general and in a limited resource setting. Lack of data limits conclusions about asthma management improvement. However, positive trends were apparent and make this approach reasonable for those considering change management strategies in a similar setting.

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