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

Nick A Francis, Christopher C Butler, Kerenza Hood, Sharon Simpson, Fiona Wood, Jacqueline Nuttall, Nick A Francis, Christopher C Butler, Kerenza Hood, Sharon Simpson, Fiona Wood, Jacqueline Nuttall

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.

Conflict of interest statement

Competing interests: None declared.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787362/bin/fran616805.f1_default.jpg
Fig 1 Study profile. *One patient from the control group was subsequently found to have longstanding asthma and was therefore determined (after consultation with the trial steering committee) to have been “recruited in error” and has not been included as a recruited patient
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787362/bin/fran616805.f2_default.jpg
Fig 2 Recruitment rates in the two groups

References

    1. McCormick A, Fleming D, Charlton J. Morbidity statistics from general practice. Fourth national study 1991-1992. London: HMSO, 1995.
    1. Butler CC, Robling M, Prout H, Hood K, Kinnersley P. Management of suspected acute viral upper respiratory tract infection in children with intranasal sodium cromoglicate: a randomised controlled trial. Lancet 2002;359:2153-8.
    1. Stott NC. Management and outcome of winter upper respiratory tract infections in children aged 0-9 years. BMJ 1979;1:29-31.
    1. Hollinghurst S, Gorst C, Fahey T, Hay AD, Hollinghurst S, Gorst C, et al. Measuring the financial burden of acute cough in pre-school children: a cost of illness study. BMC Family Practice 2008;9:10.
    1. Arroll B, Kenealy T. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Syst Rev 2005;3:CD000247.
    1. Del Mar C, Glasziou PP, Spinks A. Antibiotics for sore throat. Cochrane Database Syst Rev 2006;4:CD000023.
    1. Smith SM, Fahey T, Smucny J, Becker Lorne A. Antibiotics for acute bronchitis. Cochrane Database Syst Rev 2004;4:CD000245.
    1. Spurling GKP, Fonseka K, Doust J, Del Mar C. Antibiotics for bronchiolitis in children. Cochrane Database Syst Rev 2007;1:CD005189.
    1. Glasziou PP, Del Mar C, Sanders S, Hayem M. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev 2004;1:CD000219.
    1. National Institute for Health and Clinical Excellence. Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care (Clinical guideline 69). 2008. .
    1. Ashworth M, Charlton J, Cox K, Gulliford M, Latinovic R, Rowlands G. Why has antibiotic prescribing for respiratory illness declined in primary care? A longitudinal study using the General Practice Research Database. J Public Health 2004;26:268-74.
    1. Shapiro E. Injudicious antibiotic use: an unforeseen consequence of the emphasis on patient satisfaction? Clin Ther 2002;24:197-204.
    1. Akkerman AE, van der Wouden JC, Kuyvenhoven MM, Dieleman JP, Verheij TJM. Antibiotic prescribing for respiratory tract infections in Dutch primary care in relation to patient age clinical entities. J Antimicrob Chemother 2004;54:1116-21.
    1. Thompson PL, Spyridis N, Sharland M, Gilbert RE, Saxena S, Long PF, et al. Changes in clinical indications for community antibiotic prescribing for children in the UK from 1996-2006: will the new NICE prescribing guidance on upper respiratory tract infections be ignored? Arch Dis Child 2008; .
    1. Little P, Gould C, Williamson I, Warner G, Gantley M, Kinmonth AL. Reattendance and complications in a randomised trial of prescribing strategies for sore throat: the medicalising effect of prescribing antibiotics. BMJ 1997;315:350-2.
    1. Butler CC, Hillier S, Roberts Z, Dunstan F, Howard A, Palmer S. Antibiotic-resistant infections in primary care are symptomatic for longer and increase workload: outcomes for patients with E. coli UTIs. Br J Gen Pract 2006;56:686-92.
    1. Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients’ expectations and doctors’ perceptions of patients’ expectations—a questionnaire study. BMJ 1997;315:520-3.
    1. Kai J. What worries parents when their preschool children are acutely ill, and why: a qualitative study. BMJ 1996;313:983-6.
    1. Braun BL, Fowles JB. Characteristics and experiences of parents and adults who want antibiotics for cold symptoms. Arch Fam Med 2000;9:589-95.
    1. McWilliams DB, Jacobson RM, Van Houten HK, Naessens JM, Ytterberg KL. A program of anticipatory guidance for the prevention of emergency department visits for ear pain. Arch Pediatr Adolesc Med 2008;162:151-6.
    1. Macfarlane JT, Holmes WF, Macfarlane RM. Reducing reconsultations for acute lower respiratory tract illness with an information leaflet: A randomized controlled study of patients in primary care. Br J Gen Pract 1997;47:719-22.
    1. Macfarlane J, Holmes W, Gard P, Thornhill D, Macfarlane R, Hubbard R. Reducing antibiotic use for acute bronchitis in primary care: blinded, randomised controlled trial of patient information leaflet. BMJ 2002;324:91-4.
    1. Butler CC, Rollnick S, Kinnersley P, Jones A, Stott N. Reducing antibiotics for respiratory tract symptoms in primary care: consolidating ‘why’ and considering ‘how’. Br J Gen Pract 1998;48:1865-70.
    1. Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: Qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throats. BMJ 1998;317:637-42.
    1. Butler CC, Kinnersley P, Hood K, Robling M, Prout H, Rollnick S, et al. Clinical course of acute infection of the upper respiratory tract in children: cohort study. BMJ 2003;327:1088-9.
    1. Kallestrup P, Bro F. Parents’ beliefs and expectations when presenting with a febrile child at an out-of-hours general practice clinic. Br J Gen Pract 2003;53:43-4.
    1. Francis N, Hood K, Simpson S, Wood F, Nuttall J, Butler C. The effect of using an interactive booklet on childhood respiratory tract infections in consultations: study protocol for a cluster randomised controlled trial in primary care. BMC Family Practice 2008;9:23.
    1. Francis N, Wood F, Simpson S, Hood K, Butler CC. Developing an ‘interactive’ booklet on respiratory tract infections in children for use in primary care consultations. Patient Educ Couns 2008;73:286-93.
    1. Howie J, Heaney D, Maxwell M, Walker J. A Comparison of a Patient Enablement Instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations. Fam Pract 1998;15:165-71.
    1. Morrell DC, Avery AJ, Watkins CJ. Management of minor illness. BMJ 1980;280:769-71.
    1. Hansen BW. A randomized controlled trial on the effect of an information booklet for young families in Denmark. Patient Educ Couns 1990;16:147-50.
    1. Usherwood TP. Development and randomized controlled trial of a booklet of advice for parents. Br J Gen Pract 1991;41:58-62.
    1. Heaney D, Wyke S, Wilson P, Elton R, Rutledge P, Sommerville A, et al. Assessment of impact of information booklets on use of healthcare services: randomised controlled trial. BMJ 2001;322:1-5.
    1. Little P, Somerville J, Williamson I, Warner G, Moore M, Wiles R, et al. Randomised controlled trial of self management leaflets and booklets for minor illness provided by post. BMJ 2001;322:1214-7.
    1. Finkelstein JA, Huang SS, Kleinman K, Rifas-Shiman SL, Stille CJ, Daniel J, et al. Impact of a 16-community trial to promote judicious antibiotic use in Massachusetts. Pediatrics 2008;121:e15-23.
    1. Little P, Rumsby K, Kelly J, Watson L, Moore M, Warner G, et al. Information leaflet and antibiotic prescribing strategies for acute lower respiratory tract infection: a randomized controlled trial. JAMA 2005;293:3029-35.
    1. Roberts CR, Imrey PB, Turner JD, Hosokawa MC, Alster JM. Reducing physician visits for colds through consumer education. JAMA 1983;250:1986-9.
    1. Taylor JA, Kwan-Gett TSC, McMahon EM, Jr. Effectiveness of a parental educational intervention in reducing antibiotic use in children: a randomized controlled trial. Pediatr Infect Dis J 2005;24:489-93.
    1. Spurling GKP, Del Mar C, Dooley L, Foxlee R. Delayed antibiotics for respiratory infections. Cochrane Database Syst Rev 2007;3:CD004417.

Source: PubMed

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