Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomised controlled trial

doi:10.1136/bmj.b2885

Published 29 July 2009, doi:10.1136/bmj.b2885
Cite this as: BMJ 2009;339:b2885

Research

Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomised controlled trial

Nick A Francis, medical research council health services fellow¹^,2, Christopher C Butler, professor of primary care medicine, head of department of primary care and public health¹, Kerenza Hood, reader in statistics, director of south east Wales trials unit¹^,2, Sharon Simpson, senior research fellow¹^,2, Fiona Wood, lecturer¹, Jacqueline Nuttall, senior trial manager¹^,2

¹ Department of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN, ² South East Wales Trials Unit, School of Medicine, Cardiff University

Correspondence to: N Francis francisna{at}cf.ac.uk

Objective To establish whether an interactive booklet on respiratorytract infections in children reduces reconsultation for thesame illness episode, reduces antibiotic use, and affects futureconsulting intentions, while maintaining parental satisfactionwith care.

Design Pragmatic cluster randomised controlled trial.

Setting 61 general practices in Wales and England.

Participants 558 children (6 months to 14 years) presentingto primary care with an acute respiratory tract infection (7days or less). Children with suspected pneumonia, asthma ora serious concomitant illness, or needing immediate hospitaladmission were excluded. Three withdrew and 27 were lost tofollow-up, leaving 528 (94.6%) with main outcome data.

Interventions Clinicians in the intervention group were trainedin the use of an interactive booklet on respiratory tract infectionsand asked to use the booklet during consultations with recruitedpatients (and provide it as a take home resource). Cliniciansin the control group conducted their consultations as usual.

Main outcome measures The proportion of children who attendeda face-to-face consultation about the same illness during thetwo week follow-up period. Secondary outcomes included antibioticprescribing, antibiotic consumption, future consulting intentions,and parental satisfaction, reassurance, and enablement.

Results Reconsultation occurred in 12.9% of children in theintervention group and 16.2% in the control group (absoluterisk reduction 3.3%, 95% confidence interval –2.7% to9.3%, P=0.29). Using multilevel modelling (at the practice andindividual level) to account for clustering, no significantdifference in reconsulting was noted (odds ratio 0.75; 0.41to 1.38). Antibiotics were prescribed at the index consultationto 19.5% of children in the intervention group and 40.8% ofchildren in the control group (absolute risk reduction 21.3%,95% confidence interval 13.7 to 28.9), P<0.001). A significantdifference was still present after adjusting for clustering(odds ratio 0.29; 0.14 to 0.60). There was also a significantdifference in the proportion of parents who said they wouldconsult in the future if their child developed a similar illness(odds ratio 0.34; 0.20 to 0.57). Satisfaction, reassurance,and parental enablement scores were not significantly differentbetween the two groups.

Conclusions Use of a booklet on respiratory tract infectionsin children within primary care consultations led to importantreductions in antibiotic prescribing and reduced intention toconsult without reducing satisfaction with care.

Trial registration Current Controlled Trials ISRCTN46104365

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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