Title: Using a child’s antibiotic history as a data-enabled brief intervention to optimise antibiotic prescribing in children with acute respiratory tract infections in general practice: a feasibility study
Funder: The Academy of Medical Sciences

Abstract: Importance to the NHS At least 25% of the 300 million GP consultations in the NHS deal with children. Almost two-thirds of these consultations are for acute respiratory tract infections (RTIs). Most of these illnesses are self-limiting where antibiotics do not provide any additional clinical benefit. Yet, at least 30% of children are prescribed an antibiotic course for these acute RTIs. That’s an estimated 13 million unnecessary antibiotic prescriptions. Although there have been numerous interventions aiming to optimise antibiotic prescribing e.g. guidelines, toolkits, delayed prescribing), these have either been ineffective, had a transient effect, or difficult to roll out nationally. Aim To develop and assess the feasibility of a theory-informed, electronically delivered intervention which incorporates a child’s antibiotic history to nudge clinicians and parents to consider a no-antibiotic strategy for acute RTIs during GP consultations. Research Objectives 1. To co-develop two components of an electronically-embedded intervention (computer-screen prompt, print-out) with parents of young children, clinicians and graphic designers 2. To assess the feasibility and acceptability of this intervention in pilot GP practices, and to understand the barriers and facilitators of using the prompt during GP consultations Anticipated benefits to patients and NHS Harnessing the cognitive biases and heuristics of behavioural economics and nudge theory may interrupt the habitual behaviour to prescribe antibiotics for children with acute RTIs. Delivering such interventions, integrated into practice workflow, could be scaled up to promote effective antimicrobial stewardship and reduce unnecessary antibiotic use in primary care.

Lay abstract: Background In the NHS, one in four GP appointments are for children. Many of these appointments are for “respiratory tract infections” (RTIs) - the typical coughs, sore throats, or earaches which children get. We know that most of these illnesses will go away in time and antibiotics have little or no benefit. Yet, at least 1 in 3 children are prescribed an unnecessary course of antibiotics for these illnesses. Recent research from over 250,000 UK children has also found that children who had taken two or more antibiotic courses for these RTIs in the last year had around a 30% greater chance of not responding to treatment for future RTIs compared to children who had not taken any antibiotics. This ‘antibiotic history’ is currently not routinely used during GP appointments. Aim and research methods We want to co-develop an automated computer screen prompt and personalised consultation print-out, which will calculate a child’s antibiotic history for use during GP appointments. Through a series of ‘think aloud’ interviews, we will work together with parents, GPs and nurses on how best to do this and whether this would be acceptable for parents and clinicians. Deliverables and benefits for patients and NHS We will produce an automated computer screen prompt that is acceptable and feasible to use during GP consultations and is ready to be tested in a future trial. If shown to be effective, such automated electronic tools could be scaled up in GP practices to promote better antibiotic prescribing for children.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE;INFECTION