Development and evaluation of an interactive booklet for use in primary care consultations with children with respiratory tract infections

Francis, Nicholas A. (2009) Development and evaluation of an interactive booklet for use in primary care consultations with children with respiratory tract infections. Cardiff University, Doctoral Thesis, 284pp.

Abstract

Respiratory tract infections are the most common reason for children to consult, and be prescribed antibiotics, in primary care. Parental anxiety and misinformation can contribute to increased consulting which, combined with perceived expectations for antibiotics, can increase prescribing. Clinicians are exhorted to rationalise antibiotic prescribing, but lack evidence-based tools to achieve this. Patient education using printed materials presented by a healthcare professional has been shown to reduce reconsulting and antibiotic prescribing. I developed an interactive booklet on respiratory tract infections in children for use in primary care consultations, and training in its use. The booklet aims to address unrealistic expectations about symptom duration and antibiotic effectiveness, and increase parental empowerment by prompting clinicians to address parental concerns and expectations, and providing information about treatment options, and features that should prompt reconsultation. Booklet development was guided by behaviour change theories and guidance on developing patient materials. It involved summarising relevant scientific evidence and consulting with parents and clinicians through focus groups, and other professionals (graphic designer and a literacy expert). The intervention (booklet and training in its use) was compared with usual care in a cluster randomised controlled trial. 83 practices were randomised and 61 recruited 557 children with an acute RTI. Reconsulting, antibiotic prescribing, and parental satisfaction, enablement, and other outcomes were assessed via a telephone interview at two-weeks. Use of the intervention resulted in a non-statistically significant reduction in reconsulting, a statistically significant and clinically meaningful reduction in antibiotic prescribing (OR 0.27,95% CI 0.14 to 0.60), and no statistically significant difference in enablement, satisfaction, reassurance, or consulting over the following year. There was no statistically significant difference in total cost between study arms. Changes in clinicians' beliefs about the importance of rationalising prescribing, and using the booklet as an aide-memoir, and to support a non-prescribing approach, appear to be responsible for the reduction in prescribing.

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Contributors

Author: Nicholas A. Francis

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