Aim To investigate primary care clinicians’ views of a prototype locally relevant, real-time viral surveillance system to assist diagnostic decision-making and antibiotic prescribing for paediatric respiratory tract infections (RTI). Clinicians’ perspectives on the content, anticipated use and impact were explored to inform intervention development.
Background Children with RTIs are overprescribed antibiotics. Pressures on primary care and diagnostic uncertainty can lead to decisional biases towards prescribing. We hypothesise that real-time paediatric RTI surveillance data could reduce diagnostic uncertainty and help reduce unnecessary antibiotic prescribing.
Methodology Semistructured one-to-one interviews with 21 clinicians from a range of urban general practitioner surgeries explored the clinical context and views of the prototype system. Transcripts were analysed using thematic analysis.
Results Though clinicians self-identified as rational (not over)prescribers, cognitive biases influenced antibiotic prescribing decisions. Clinicians sought to avoid ‘anticipated regret’ around not prescribing for a child who then deteriorated. Clinicians were not aware of formal infection surveillance information sources (tending to assume many viruses are around), perceiving the information as novel and potentially useful. Perceptions of surveillance information as presented included: not relevant to decision-making/management; useful to confirm decisions post hoc; and increasing risks of missing sick children. Clinicians expressed wariness of using population-level data to influence individual patient decision-making and expressed preference for threat (high-risk) information identified by surveillance, rather than reassuring information about viral RTIs.
Conclusions More work is needed to develop a surveillance intervention if it is to beneficially influence decision-making and antibiotic prescribing in primary care. Key challenges for developing interventions are how to address cognitive biases and how to communicate reassuring information to risk-oriented clinicians.
- general paediatrics
- infectious diseases
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Presented at This research was presented at the General Practice Research on Infections Network (GRIN) conference, University of Oxford in September 2016, and was presented as part of the CAPC seminar series at the University of Bristol on 21 March 2017.
Contributors ECA was responsible for developing the current research question and secured funding and ethical approval, coordinated the study, led on data collection (interviews) and full analysis, wrote the paper and will act as guarantor. ADH was responsible for the idea of developing a paediatric infection surveillance intervention. IL developed mock-up infection surveillance materials to present within interviews and helped with data collection and analysis. JMK, TM and CC advised on qualitative methods and contributed to analysis. All authors have read, commented on and approved the final manuscript.
Funding The study is supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions at the University of Bristol, in partnership with Public Health England (PHE). ADH was funded by NIHR Research Professorship (NIHR-RP-02-12-012). JMK was partly funded by NIHR HPRU in Evaluation of Interventions and NIHR Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust (UHBT).
Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The South-West Frenchay Bristol Research Ethics Committee approved the study (reference: 15/SW/0264).
Provenance and peer review Not commissioned; externally peer reviewed.
Author note The work was mainly completed within the Centre for Academic Primary Care, Population Health Sciences, University of Bristol. The University of Bristol acted as study sponsor. Doctoral supervision was provided for the lead author (ECA) by TM within Health and Social Sciences, University of the West of England (UWE). ECA submitted a body of work from which this paper was drawn as partial submission for the award of Professional Doctorate in Health Psychology.
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