“It's safer to …” parent consulting and clinician antibiotic prescribing decisions for children with respiratory tract infections: An analysis across four qualitative studies

Abstract

This paper reports a cross-study analysis of four studies, aiming to understand the drivers of parental consulting and clinician prescribing behaviour when children under 12 years consult primary care with acute respiratory tract infections (RTI). Qualitative data were obtained from three primary studies and one systematic review. Purposeful samples were obtained for (i) a focus group study of parents' information needs and help seeking; (ii) an interview study of parents' experiences of primary health care (60 parents in total); and (iii) an interview study of clinicians' experiences of RTI consultations for children (28 clinicians). The systematic review synthesised parent and clinician views of prescribing for children with acute illness. Reoccurring themes and common patterns across the whole data set were noted. Through an iterative approach involving re-examination of the primary data, translation of common themes across all the studies and re-organisation of these themes into conceptual groups, four overarching themes were identified. These were: the perceived vulnerability of children; seeking safety in the face of uncertainty; seeking safety from social disapproval; and experience and perception of safety. The social construction of children as vulnerable and normative beliefs about the roles of parents and clinicians were reflected in parents' and clinicians' beliefs and decision making when a child had an RTI. Consulting and prescribing antibiotics were both perceived as the safer course of action. Therefore perception of a threat or uncertainty about that threat tended to lead to parental consulting and clinician antibiotic prescribing. Clinician and parent experience could influence the perception of safety in either direction, depending on whether previous action had resulted in perceived increases or decreases in safety. Future interventions aimed at reducing unnecessary consulting or antibiotic prescribing need to consider how to make the desired action fit with social norms and feel safer for parents and clinicians.

Development and internal validation of a clinical rule to improve antibiotic use in children presenting to primary care with acute respiratory tract infection and cough: a prognostic cohort study

“…Primary care clinicians acknowledge that they prescribe antibiotics for a range of medical and non-medical reasons, 10 particularly in children, who are seen as vulnerable 11 and whose clinical state can change rapidly. Many clinicians report that they prescribe antibiotics just in case, 12 to mitigate perceived risk of future hospital admission and complications,13, 14 and that failing to provide a prescription for a child who subsequently becomes seriously unwell is professionally unacceptable 11 . If primary care clinicians could identify children at low (or very low) risk of such future complications, the reduced clinical uncertainty could lead to a reduced use of antibiotics in these groups of patients.…”

Special Issue: Complexity, Routines, and Reflexivity in Professional Work

“…These studies consider how risk gets translated into different contexts (see Arribas-Ayllon & Sarangi, 2014;Burton-Jeangros, Cavalli, Gouilhers, & Hammer, 2013), how practitioners intervene to minimise risks in practice (see Cabral, Lucas, Ingram, Hay, & Horwood, 2015;Cricco-Lizza, 2010), and/or how caring is carried out amid (or in spite of) contexts characterised in terms of risk (see Broom, Broom, & Kirby, 2014;Iversen, Broström, & Ulander, 2017). These three features of risk work-interpreting risk knowledge, intervening to minimize risk, and handling social relations and interactions-are illuminated in these studies alongside some connections between them (Gale et al, 2016).…”

Community paediatric respiratory infection surveillance study protocol: a feasibility, prospective inception cohort study

“…6 GPs tend towards prescribing antibiotics in the face of uncertainty for paediatric RTIs, due to a perception that not prescribing carries greater potential threat. 11 The Chief Medical Officer's 2011 Annual Report identifies a need for enhanced surveillance of infectious diseases, with a focus on tackling AMR and improving antibiotic stewardship, and recommends research to enhance infectious disease surveillance. 12 Currently available UK healthcare-based infection surveillance information includes microbiology data presented in weekly laboratory reports from the Public Health England (PHE) based on swabs predominantly received from secondary care.…”