The prevalence of food allergy appears to be on the rise in Australian children. Yet paediatricians have had little training in allergy care and allergists currently diagnose and manage most food allergy. This had led to long waiting times for an allergist appointment (12-18 months in public hospital systems).
To address this, the Australian Paediatric Research Network endorsed Paed Action on Food Allergy project will develop and pilot an online training and clinical decision support package for community paediatricians, to effectively manage simple food allergy in non-hospital settings.
The pilot assesses:
(i) Paediatrician knowledge and competency in the management of food allergy;
(ii) acceptability of the package by a sample of metropolitan and rural paediatricians;
(iv) change in child quality of life; and
(v) parent mental health of the families who receive services from the participating paediatricians.
35 children aged between 1 month and 7 years were recruited from the Royal Children's Hospital Allergy Clinic Waitlist, with 26 (76%) completing follow up surveys. Families were allocated to a Paediatrician within 10km of their residence, reducing travel time as well as time to diagnosis and management.
Families and paediatricians report that this new model of care is highly acceptable:
- 80% of cases were managed by the General Paediatricians, with only 7 of the 34 children requiring follow up assessment by an Allergist for complex food allergy.
- 94% of families reported to be happy with the care received.
- 68% of families would pay the out of pocket expense (estimated at $150/family) for this care
- Paediatricians report improved knowledge, competency and confidence in managing food allergy
- Contrary to our initial expectations, child quality of life and parent mental health at baseline were unimpaired so our pilot did not improve these outcomes per se at follow up.
The positive outcomes from this pilot have informed a Project Grant application through the National Health & Medical Research Council for an Australian randomised control trial. If funded, the trial will take place in Melbourne and Adelaide and will provide the best evidence yet that our new model of care can safely and effectively relieve some of the burden of food allergy management from the overwhelmed tertiary sector.
Investigators: The pilot is co-led by A/Professor Harriet Hiscock and Dr Margie Danchin with CIs A/Professors Katie Allen and Mimi Tang, Murdoch Childrens Research Institute, Melbourne.
Start date: August 2012
End date: April 2013
Funding bodies: Scobie and Claire Mackinnon Trust, the Victorian Paediatric Network and the Murdoch Childrens Research Institute.
Ethics approval: HREC#32184, The Royal Children’s Hospital, Vic