• Br J Gen Pract · Jun 2024

    Randomized Controlled Trial

    Implementation of CHIldren with acute COugh (CHICO) intervention to improve antibiotics management: qualitative study.

    • Clare Clement, Jenny Ingram, Christie Cabral, Peter S Blair, Alastair D Hay, Penny Seume, and Jeremy Horwood.
    • Centre for Appearance Research, University of the West of England (UWE Bristol), Bristol.
    • Br J Gen Pract. 2024 Jun 1; 74 (743): e401e407e401-e407.

    BackgroundChildhood respiratory tract infections (RTIs) are common and can lead to unnecessary antibiotic use and antimicrobial resistance. The CHIldren with COugh (CHICO) intervention incorporates a clinician-focused algorithm (STARWAVe) to predict future hospitalisation risk, elicitation of carer concerns, and a carer-focused personalised leaflet recording treatment decisions and safety-netting information.AimTo examine the implementation of the CHICO intervention by primary care clinicians.Design And SettingA qualitative study with primary care clinicians in England taking part in the CHICO randomised controlled trial.MethodInterviews explored the CHICO intervention's acceptability and use. Clinicians from a range of practices with high and low antibiotic dispensing rates were recruited. Normalisation process theory underpinned data collection and thematic analysis.ResultsMost clinicians liked the intervention because it was quick and easy to use, it helped elicit carer concerns, and reassured clinicians and carers of the appropriateness of treatment decisions. However, clinicians used it as a supportive aid for treatment decisions rather than as a tool for behaviour change. The accompanying advice leaflet helped explain treatment decisions and support self-care. The intervention did not always align with clinicians' usual processes, which could affect use. Increased familiarisation with the algorithm led to reduced intervention use, which was further reduced during the COVID-19 pandemic as a result of changes to practice and remote consultations.ConclusionClinicians found the CHICO intervention useful to support decision making around antibiotic prescribing and it helped discussions with carers about concerns and treatment decisions. The intervention may need to be adapted to align more with clinicians' consultation flow and remote consultations.© The Authors.

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