In the medium term, a focus on reducing exposure to wheeze triggers could have huge impact. Options range from stricter air pollution laws, more handwashing in schools, more vaccination against respiratory viruses associated with wheeze attacks in children, more antivirals in the management of virus-induced wheeze attacks, and a better understanding of how we can use respiratory virus testing in the clinical care pathway (to estimate the risk of recurrent wheeze attacks).
PROMS can also encourage an integrated approach to care by supporting earlier identification in primary care of children who would benefit from specialist review; in turn, following specialist review, PROMS can support primary care physicians to continue to take a lead role in the care of the child. Without specific tools, such as PROMS, telemedicine might otherwise restrain discussion between physicians and caregivers about important factors other than clinical symptoms. Key topics addressed in PROMS include understanding care plans, navigation of the new digital health-care system, and discussion of concerns around returning to school. PROMs can, therefore, help ensure gaps in communication during virtual clinic appointments are mitigated.
Alongside PROMS, patient reported experience measures (PREMS) can assess and improve quality of care. Routinely asking caregivers of preschool children with wheeze to feedback about the care their children receive will help clinicians understand whether digital preschool management works for all and to identify areas for improvement in delivery of care.
The COVID-19 pandemic experience highlights that large reductions in hospital activity for preschool wheeze are possible. The transition to delivering more remote care for children with preschool wheeze offers opportunities for rapid, convenient care. Potential risks have been identified, particularly in acute assessment and management of sick children, but these risks can be mitigated through a greater focus on education and partnership working with caregivers when their children are well. PROMS and PREMS have a key part in building these partnerships with parents, grounded in greater focus on their needs, which could transform outcomes as well as safety, efficiency, and experience of services in the future.
We declare no competing interests. DH is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration North West London. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
Published: August 04, 2020
© 2020 Elsevier Ltd. All rights reserved.
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