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Feasibility cluster randomised controlled trial of a within-consultation intervention to reduce antibiotic prescribing for children presenting to primary care with acute respiratory tract infection and cough

Feasibility cluster randomised controlled trial of a within-consultation intervention to reduce antibiotic prescribing for children presenting to primary care with acute respiratory tract infection and cough
Feasibility cluster randomised controlled trial of a within-consultation intervention to reduce antibiotic prescribing for children presenting to primary care with acute respiratory tract infection and cough
Objective To investigate recruitment and retention, data collection methods and the acceptability of a ‘within-consultation’ complex intervention designed to reduce antibiotic prescribing. Design Primary care feasibility cluster randomised controlled trial. Setting 32 general practices in South West England recruiting children from October 2014 to April 2015. Participants Children (aged 3 months to <12 years) with acute cough and respiratory tract infection (RTI). Intervention A web-based clinician-focussed clinical rule to predict risk of future hospitalisation and a printed leaflet with individualised child health information for carers, safety-netting advice and a treatment decision record. Controls Usual practice, with clinicians recording data on symptoms, signs and treatment decisions. Results Of 542 children invited, 501 (92.4%) consented to participate, a month ahead of schedule. Antibiotic prescribing data were collected for all children, follow-up data for 495 (98.8%) and the National Health Service resource use data for 494 (98.6%). The overall antibiotic prescribing rates for children’s RTIs were 25% and 15.8% (p=0.018) in intervention and control groups, respectively. We found evidence of postrandomisation differential recruitment: the number of children recruited to the intervention arm was higher (292 vs 209); over half were recruited by prescribing nurses compared with less than a third in the control arm; children in the intervention arm were younger (median age 2 vs 3 years controls, p=0.03) and appeared to be more unwell than those in the control arm with higher respiratory rates (p<0.0001), wheeze prevalence (p=0.007) and global illness severity scores assessed by carers (p=0.045) and clinicians (p=0.01). Interviews with clinicians confirmed preferential recruitment of less unwell children to the trial, more so in the control arm. Conclusion Differential recruitment may explain the paradoxical antibiotic prescribing rates. Future cluster level studies should consider designs which remove the need for individual consent postrandomisation and embed the intervention within electronic primary care records.
2044-6055
1-11
Blair, Peter S.
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Turnbull, Sophie
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Jenny, Ingram
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Redmond, Niamh
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Lucas, Patricia Jane
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Cabral, Christie
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Hollinghurst, Sandra
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Dixon, Padraig
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Peters, Tim
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Horwood, Jeremy
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Little, Paul
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Francis, Nicholas Andrew
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Gilbertson, Anna
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Jameson, Catherine
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Hay, Alastair D
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Blair, Peter S.
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Turnbull, Sophie
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Jenny, Ingram
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Redmond, Niamh
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Lucas, Patricia Jane
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Cabral, Christie
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Hollinghurst, Sandra
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Dixon, Padraig
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Peters, Tim
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Horwood, Jeremy
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Little, Paul
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Francis, Nicholas Andrew
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Gilbertson, Anna
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Jameson, Catherine
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Hay, Alastair D
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Blair, Peter S., Turnbull, Sophie, Jenny, Ingram, Redmond, Niamh, Lucas, Patricia Jane, Cabral, Christie, Hollinghurst, Sandra, Dixon, Padraig, Peters, Tim, Horwood, Jeremy, Little, Paul, Francis, Nicholas Andrew, Gilbertson, Anna, Jameson, Catherine and Hay, Alastair D (2017) Feasibility cluster randomised controlled trial of a within-consultation intervention to reduce antibiotic prescribing for children presenting to primary care with acute respiratory tract infection and cough. BMJ Open, 7 (5), 1-11. (doi:10.1136/bmjopen-2016-014506).

Record type: Article

Abstract

Objective To investigate recruitment and retention, data collection methods and the acceptability of a ‘within-consultation’ complex intervention designed to reduce antibiotic prescribing. Design Primary care feasibility cluster randomised controlled trial. Setting 32 general practices in South West England recruiting children from October 2014 to April 2015. Participants Children (aged 3 months to <12 years) with acute cough and respiratory tract infection (RTI). Intervention A web-based clinician-focussed clinical rule to predict risk of future hospitalisation and a printed leaflet with individualised child health information for carers, safety-netting advice and a treatment decision record. Controls Usual practice, with clinicians recording data on symptoms, signs and treatment decisions. Results Of 542 children invited, 501 (92.4%) consented to participate, a month ahead of schedule. Antibiotic prescribing data were collected for all children, follow-up data for 495 (98.8%) and the National Health Service resource use data for 494 (98.6%). The overall antibiotic prescribing rates for children’s RTIs were 25% and 15.8% (p=0.018) in intervention and control groups, respectively. We found evidence of postrandomisation differential recruitment: the number of children recruited to the intervention arm was higher (292 vs 209); over half were recruited by prescribing nurses compared with less than a third in the control arm; children in the intervention arm were younger (median age 2 vs 3 years controls, p=0.03) and appeared to be more unwell than those in the control arm with higher respiratory rates (p<0.0001), wheeze prevalence (p=0.007) and global illness severity scores assessed by carers (p=0.045) and clinicians (p=0.01). Interviews with clinicians confirmed preferential recruitment of less unwell children to the trial, more so in the control arm. Conclusion Differential recruitment may explain the paradoxical antibiotic prescribing rates. Future cluster level studies should consider designs which remove the need for individual consent postrandomisation and embed the intervention within electronic primary care records.

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e-pub ahead of print date: 9 May 2017
Published date: 9 May 2017

Identifiers

Local EPrints ID: 436490
URI: http://eprints.soton.ac.uk/id/eprint/436490
ISSN: 2044-6055
PURE UUID: 441c917b-5646-416e-960d-f084a1b06ae6
ORCID for Nicholas Andrew Francis: ORCID iD orcid.org/0000-0001-8939-7312

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Date deposited: 11 Dec 2019 17:30
Last modified: 09 Jan 2022 04:08

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Contributors

Author: Peter S. Blair
Author: Sophie Turnbull
Author: Ingram Jenny
Author: Niamh Redmond
Author: Patricia Jane Lucas
Author: Christie Cabral
Author: Sandra Hollinghurst
Author: Padraig Dixon
Author: Tim Peters
Author: Jeremy Horwood
Author: Paul Little
Author: Anna Gilbertson
Author: Catherine Jameson
Author: Alastair D Hay

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