Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomised controlled trial

Abstract

Objective To establish whether an interactive booklet on respiratory tract infections in children reduces reconsultation for the same illness episode, reduces antibiotic use, and affects future consulting intentions, while maintaining parental satisfaction with care.Design Pragmatic cluster randomised controlled trial. Setting 61 general practices in Wales and England.Participants 558 children (6 months to 14 years) presenting to primary care with an acute respiratory tract infection (7 days or less). Children with suspected pneumonia, asthma or a serious concomitant illness, or needing immediate hospital admission were excluded. Three withdrew and 27 were lost to follow-up, leaving 528 (94.6%) with main outcome data.Interventions Clinicians in the intervention group were trained in the use of an interactive booklet on respiratory tract infections and asked to use the booklet during consultations with recruited patients (and provide it as a take home resource). Clinicians in the control group conducted their consultations as usual.Main outcome measures The proportion of children who attended a face-to-face consultation about the same illness during the two week follow-up period. Secondary outcomes included antibiotic prescribing, antibiotic consumption, future consulting intentions, and parental satisfaction, reassurance, and enablement.Results Reconsultation occurred in 12.9% of children in the intervention group and 16.2% in the control group (absolute risk reduction 3.3%, 95% confidence interval −2.7% to 9.3%, P=0.29). Using multilevel modelling (at the practice and individual level) to account for clustering, no significant difference in reconsulting was noted (odds ratio 0.75; 0.41 to 1.38). Antibiotics were prescribed at the index consultation to 19.5% of children in the intervention group and 40.8% of children in the control group (absolute risk reduction 21.3%, 95% confidence interval 13.7 to 28.9), P<0.001). A significant difference was still present after adjusting for clustering (odds ratio 0.29; 0.14 to 0.60). There was also a significant difference in the proportion of parents who said they would consult in the future if their child developed a similar illness (odds ratio 0.34; 0.20 to 0.57). Satisfaction, reassurance, and parental enablement scores were not significantly different between the two groups.Conclusions Use of a booklet on respiratory tract infections in children within primary care consultations led to important reductions in antibiotic prescribing and reduced intention to consult without reducing satisfaction with care.Trial registration Current Controlled Trials ISRCTN46104365

Clinicians’ Views and Experiences of Interventions to Enhance the Quality of Antibiotic Prescribing for Acute Respiratory Tract Infections

“…Using (interactive) booklets in RTI consultations has been shown to be effective at helping to reduce prescribing by clinicians and reducing intentions to consult by patients. 6,28,29 Our results are consistent with a qualitative evaluation of use of an interactive booklet in children in which use of the booklet was shown to increase clinician confidence in adopting a non-prescribing approach, and increased knowledge about the management of RTIs. 28 One limitation of this study is the use of six interviewers.…”

“…[3][4][5] However, they have generally been designed for implementation in a single context 6,7 and have focused on a single country, health care organisation and culture.…”

Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial

“…Our results are consistent with those from a previous study in which the use of an interactive booklet about childhood respiratory tract infections in primary care consultations led to a significant reduction in antibiotic prescribing. 25 In another recent study, a combination of online educational modules and a seminar on motivational interviewing led to a reduction in dispensing of oral antibiotics with no significant change in admissions to hospital, repeat consultations or costs. 26 These studies indicate that a combination of live and media education are generally effective in changing physician performance in the context of antibiotic use for acute respiratory infections.…”

“…• Out of 213 patients, 178 eligible patients consulted 72 physicians; median practice size = 16 physicians, range [14][15][16][17][18][19][20][21][22][23][24][25][26] Units included in the intervention group n = 5 teaching units. We excluded physicians who had participated in the DECISION+ pilot trial 13 or who did not expect to practise in the teaching unit during the trial period.…”

Antibiotic Prescribing During Pediatric Ambulatory Care Visits for Asthma

“…This finding is consistent with others that have demonstrated a relationship between education and more judicious use of antibiotics for pediatric upper respiratory illnesses. [34][35][36] Patient asthma education is increasingly being viewed as an important marker of quality of care in the ambulatory care setting. 37 The results from this finding suggest other potential benefits for asthma education, as it seems to be associated with more judicious use of antibiotics by providers.…”