Title: PREparing for Improving the use of NHS primary care services and Antibiotics for Children with respiratory Tract infections (Pre-INACT)
Funder: Department of Health and Social Care

Abstract: Respiratory tract infections (RTI) are a common childhood illness. Parents, particularly new parents, can feel anxious about how to interpret and manage RTI symptoms and unsure about when to consult a doctor. RTIs are the most common reason for child visits to primary care and also the most common reason for children to be given antibiotics. Most RTIs will get better without treatment, but a small minority develop into a more severe illness. Too many antibiotics are prescribed for children s RTIs, contributing to the rise of antibiotic resistant bacteria. Our previous research has shown clinicians are more likely to prescribe antibiotics in the presence of specific symptoms and signs (which are not always evidence based), what they think parents expect, uncertainty about how the illness will progress and concerns for the safety of the child. The aims of this PDG research are: to identify what influences parents to visit a doctor (GP or at A&E) for a child with RTI; to explore the best ways to design a web-based tool which could both support parents to decide when to consult and support clinicians in more evidence-based antibiotic prescribing. This research has two elements: 1) a review of the scientific literature about what influences parents to consult a doctor when their child as a RTI; and 2) interviews with parents and clinicians to identify the optimal characteristics of an online tool for use by both. For the systematic literature review, we will evaluate previous studies and combine their findings to estimate the relative importance of the different factors influencing parents decision to consult. For the interview study, we will talk to a range of parents from communities of different levels of deprivation and ethnicity to find out about the facilitators and barriers to online web-tool use (for helping parents decide when to visit the doctor). We will also interview primary care clinicians (GP and practice nurses) and other key practice staff about the potential for incorporating a web-tool into their systems for a) supporting evidence-based antibiotic prescribing by clinicians and b) providing better information to parents about managing RTI in children, including supporting parents to decide when to seek an appointment or treatment. This PDG research will support the development of a future larger research programme which will design and test an intervention to support improved management of RTIs in children by parents and clinicians. Before finalising the design of this larger programme, we wish to investigate whether an on-line tool was a suitable intervention and whether parents and clinicians would use it. This PDG research is designed to address these issues.

Lay abstract: Respiratory tract infections (RTI) are a common childhood illness. Parents, particularly new parents, can feel anxious about how to interpret and manage RTI symptoms and unsure about when to consult a doctor. RTIs are the most common reason for child visits to primary care and also the most common reason for children to be given antibiotics. Most RTIs will get better without treatment, but a small minority develop into a more severe illness. Too many antibiotics are prescribed for children s RTIs, contributing to the rise of antibiotic resistant bacteria. Our previous research has shown clinicians are more likely to prescribe antibiotics in the presence of specific symptoms and signs (which are not always evidence based), what they think parents expect, uncertainty about how the illness will progress and concerns for the safety of the child. The aims of this PDG research are: to identify what influences parents to visit a doctor (GP or at A&E) for a child with RTI; to explore the best ways to design a web-based tool which could both support parents to decide when to consult and support clinicians in more evidence-based antibiotic prescribing. This research has two elements: 1) a review of the scientific literature about what influences parents to consult a doctor when their child as a RTI; and 2) interviews with parents and clinicians to identify the optimal characteristics of an online tool for use by both. For the systematic literature review, we will evaluate previous studies and combine their findings to estimate the relative importance of the different factors influencing parents decision to consult. For the interview study, we will talk to a range of parents from communities of different levels of deprivation and ethnicity to find out about the facilitators and barriers to online web-tool use (for helping parents decide when to visit the doctor). We will also interview primary care clinicians (GP and practice nurses) and other key practice staff about the potential for incorporating a web-tool into their systems for a) supporting evidence-based antibiotic prescribing by clinicians and b) providing better information to parents about managing RTI in children, including supporting parents to decide when to seek an appointment or treatment. This PDG research will support the development of a future larger research programme which will design and test an intervention to support improved management of RTIs in children by parents and clinicians. Before finalising the design of this larger programme, we wish to investigate whether an on-line tool was a suitable intervention and whether parents and clinicians would use it. This PDG research is designed to address these issues.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;7.1 INDIVIDUAL CARE NEEDS
Health categories: INFECTION