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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

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
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
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
1-8
Francis, Nicholas Andrew
9b610883-605c-4fee-871d-defaa86ccf8e
Butler, Christopher Collett
d2f9102c-54c2-4570-be4e-32324c8c8f1d
Hood, Kerenza
af7cf839-ca85-4ea9-83c3-3dd31be88b32
Simpson, Sharon Anne
9b735262-6af7-40c4-a2d6-6a43cb2ddd00
Wood, Fiona Claire
7fa2fcc6-81ab-4acf-997e-4c7113c7b1fd
Nuttall, Jacqueline
154aec0a-05f2-4379-918e-9c36767fdc4c
Francis, Nicholas Andrew
9b610883-605c-4fee-871d-defaa86ccf8e
Butler, Christopher Collett
d2f9102c-54c2-4570-be4e-32324c8c8f1d
Hood, Kerenza
af7cf839-ca85-4ea9-83c3-3dd31be88b32
Simpson, Sharon Anne
9b735262-6af7-40c4-a2d6-6a43cb2ddd00
Wood, Fiona Claire
7fa2fcc6-81ab-4acf-997e-4c7113c7b1fd
Nuttall, Jacqueline
154aec0a-05f2-4379-918e-9c36767fdc4c

Francis, Nicholas Andrew, Butler, Christopher Collett, Hood, Kerenza, Simpson, Sharon Anne, Wood, Fiona Claire and Nuttall, Jacqueline (2009) 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. British Medical Journal, 339, 1-8, [b2885]. (doi:10.1136/bmj.b2885).

Record type: Article

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

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More information

Accepted/In Press date: 4 March 2009
Published date: 29 July 2009
Additional Information: Pdf uploaded in accordance with publisher's policy at http://www.sherpa.ac.uk/romeo/issn/0959-8138/ (accessed 27/02/2014)

Identifiers

Local EPrints ID: 436268
URI: http://eprints.soton.ac.uk/id/eprint/436268
PURE UUID: 28aa99e5-4145-4e54-a10f-849033a30500
ORCID for Nicholas Andrew Francis: ORCID iD orcid.org/0000-0001-8939-7312

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Date deposited: 05 Dec 2019 17:30
Last modified: 08 Jan 2022 03:40

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Contributors

Author: Christopher Collett Butler
Author: Kerenza Hood
Author: Sharon Anne Simpson
Author: Fiona Claire Wood
Author: Jacqueline Nuttall

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