The TARGET Programme
The Programme started in 2010 and will complete in March 2016.
Respiratory tract infections (RTIs) in children present a major problem to health care services internationally for three reasons:
- They are extremely common and costly to service providers, families, schools and parents’ employers.
- Clinicians remain uncertain about how to diagnosis and best manage RTIs in children.
- Overusing antibiotics can lead to antimicrobial resistance and re-enforces the belief that parents should consult for similar symptoms in the future.
The overall aim of the Programme is to improve the quality of care given to children presenting to primary care with RTIs. The Programme consists of five Workstreams (WS) using mixed methods to: review existing data in WS1; explore the experiences of parents and clinicians in WS2; develop a clinical prediction rule to predict future hospitalisation for RTI in WS3; integrate the evidence found in WS1-3 in WS(t), which led to developing an intervention to improve the targeting of antibiotics and parental health seeking behaviour for children with RTIs; evaluate in WS4.
The programme, funded by the National Institute for Health Research Programme Grants for Applied Research Programme,found new evidence to help parents, primary care clinicians (doctors and nurses) and policy makers support improved antimicrobial stewardship in primary care.
The main findings of the five-year research programme are:
- Symptoms of respiratory tract infections in children last longer than many parents and clinicians expect (some for more than 21 days), and that this information is of great value to parents to help them know what to expect after seeing the doctor or nurse
- An important driver of antibiotic prescribing is clinical uncertainty - clinicians will adopt a "treat just in case" strategy when they are unsure if a child's condition could get worse (eg need hospitalisation) and they would welcome any evidence that helps them identify which children will get worse.
- Parents value consistent advice from a trusted source, which addresses their common concerns about their child’s RTI, and would value more advice about symptom relief and more precise safety netting advice.
- Experience and training in recognising severe RTIs, plus more evidence to identify the children at highest and lowest risk of illness deterioration, may help clinicians to identify children most and least likely to benefit from antibiotics.
- The most effective interventions to improve antibiotic use target parents and clinicians during consultations; promote clinician leadership in the intervention design; provide automatic prescribing prompts; and employ delayed prescribing.
The team is currently writing up the results for publication, both within workstreams and across them, generating further research ideas and disseminating the work for public, clinical and NHS attention.