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Publication - Dr Jenny Ingram

    Primary care clinician antibiotic prescribing decisions in consultations for children with RTIs

    a qualitative interview study

    Citation

    Horwood, J, Cabral, C, Hay, AD & Ingram, J, 2016, ‘Primary care clinician antibiotic prescribing decisions in consultations for children with RTIs: a qualitative interview study’. British Journal of General Practice, vol 66., pp. e207-e213

    Abstract

    Background
    Respiratory tract infections (RTIs) are a major primary care challenge
    in children because they are common and costly, there is uncertainty
    regarding their diagnosis, prognosis, and management, and the overuse of
    antibiotics leads to illness medicalisation and bacterial resistance.

    Aim To investigate healthcare professional (HCP) diagnostic and antibiotic prescribing decisions for children with RTIs.

    Design and setting
    Semi-structured interviews conducted with 22 GPs and six nurses. HCPs
    were recruited from six general practices and one walk-in centre,
    serving a mix of deprived and affluent areas.

    Method Interviews were audiorecorded, transcribed, imported into NVivo 9, and analysed thematically.

    Results
    HCPs varied in the symptom and clinical examination findings used to
    identify children they thought might benefit from antibiotics. Their
    diagnostic reasoning and assessment of perceived clinical need for
    antibiotics used a dual process, combining an initial rapid assessment
    with subsequent detailed deductive reasoning. HCPs reported confidence
    diagnosing and managing most minor and severe RTIs. However, residual
    prognostic uncertainty, particularly for the intermediate illness
    severity group, frequently led to antibiotic prescribing to mitigate the
    perceived risk of subsequent illness deterioration. Some HCPs perceived
    a need for more paediatrics training to aid treatment decisions. The
    study also identified a number of non-clinical factors influencing
    prescribing.

    Conclusion
    Prognostic uncertainty remains an important driver of HCPs’ antibiotic
    prescribing. Experience and training in recognising severe RTIs,
    together with more evidence to help HCPs identify the children at risk
    of future illness deterioration, may support HCPs’ identification of the
    children most and least likely to benefit from antibiotics.

    Full details in the University publications repository