• Rebecca Heath, Paul Tomaszewski, Michael Kuri, Vincent Atua, and Georgina Phillips.
• Royal Hobart Hospital, Hobart, Tasmania, Australia.
• Emerg Med Australas. 2019 Feb 1; 31 (1): 97-104.

ObjectiveTo 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.MethodsAn 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.ResultsAsthma 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.ConclusionThis 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.© 2018 Australasian College for Emergency Medicine.

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