Recognition and management of protracted bacterial bronchitis in Australian Aboriginal children: a knowledge translation approach.

Chronic wet cough in children is the hallmark symptom of protracted bacterial bronchitis (PBB) and if left untreated can lead to bronchiectasis, which is prevalent in Indigenous populations. Under-recognition of chronic wet cough by parents and clinicians and under-diagnosis of PBB by clinicians are known.We aimed to improve recognition and management of chronic wet cough in Aboriginal children using knowledge translation (KT), a methodological approach that can be adapted for use in Indigenous contexts to facilitate effective and sustained translation of research into practice.A mixed-methods KT study undertaken at a remote-based Aboriginal primary medical service (February-2017 to December-2019). Our KT strategy included: (i) culturally secure (i.e. ensuring Aboriginal people are treated with regard to their unique cultural needs and differences) knowledge dissemination to facilitate family health seeking for chronic wet cough in children and (ii) an implementation strategy to facilitate correct diagnosis and management of chronic wet cough and PBB by clinicians.Post KT, health seeking for chronic wet cough increased by 184% (pre=8/630 (1.3%), post=23/636 children (3.6%), p=0.007, 95%CI 0.7%, 4.0%). Clinician proficiency in management of chronic wet cough improved significantly as reflected by (i) improved chronic cough related quality of life (p<0.001, 95%CI 0·8, 3·0) and (ii) improved clinician assessment of cough quality (p<0.001, 95%CI10.4%, 23.0%), duration (p<0.001, 95%CI 11.1%, 24.1%) and appropriate antibiotic prescription (p=0.010, 95%CI 6.6%, 55.7%).Health seeking for children with chronic wet cough can be facilitated through provision of culturally secure health information. Clinician proficiency in the management of PBB can be improved with KT strategies which include training in culturally informed management, leading to better health outcomes. Comprehensive strategies that include both families and health systems are required to ensure that chronic wet cough in children is detected and optimally managed.

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