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
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
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DOI：
10.1136/bmj.b2885
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发表时间：
2009-07-29
影响因子：
105.7
通讯作者：
Nuttall, Jacqueline
中科院分区：
文献类型：
--
作者：
Francis, Nick A.;Butler, Christopher C.;Nuttall, Jacqueline
目的 确定关于儿童呼吸道感染的互动小册子是否可以减少同一疾病发作的复诊、减少抗生素使用并影响未来的咨询意图，同时保持家长对护理的满意度。设计实用的整群随机对照试验。在威尔士和英格兰设置 61 个常规做法。参与者 558 名因急性呼吸道感染（7 天或更短）到初级保健机构就诊的儿童（6 个月至 14 岁）。患有疑似肺炎、哮喘或严重伴随疾病或需要立即入院的儿童被排除在外。 3 例退出，27 例失访，留下 528 例 (94.6%) 的主要结果数据。 干预措施 干预组的临床医生接受了如何使用呼吸道感染交互式小册子的培训，并要求在与招募的患者会诊时使用该小册子（并将其作为带回家的资源提供）。对照组临床医生如常进行会诊。 主要观察指标 两周随访期间就同一疾病参加面对面会诊的儿童比例。次要结局包括抗生素处方、抗生素使用、未来咨询意向以及家长满意度、放心和支持。 结果 干预组中 12.9% 的儿童和对照组中 16.2% 的儿童进行了复诊（绝对风险降低 3.3%，95% 置信区间 - 2.7% 至 9.3%，P=0.29）。使用多级建模（在实践和个人层面）来解释聚类，未发现重新咨询的显着差异（比值比 0.75；0.41 至 1.38）。干预组 19.5% 的儿童和对照组 40.8% 的儿童在指数咨询时服用了抗生素（绝对风险降低 21.3%，95% 置信区间 13.7 至 28.9），P
Objective To establish whether an interactive booklet on respiratory tract infections in children reduces reconsultation for the same illness episode, reduces antibiotic use, and affects future consulting intentions, while maintaining parental satisfaction with care.Design Pragmatic cluster randomised controlled trial.Setting 61 general practices in Wales and England.Participants 558 children (6 months to 14 years) presenting to primary care with an acute respiratory tract infection (7 days or less). Children with suspected pneumonia, asthma or a serious concomitant illness, or needing immediate hospital admission were excluded. Three withdrew and 27 were lost to follow-up, leaving 528 (94.6%) with main outcome data.Interventions Clinicians in the intervention group were trained in the use of an interactive booklet on respiratory tract infections and asked to use the booklet during consultations with recruited patients (and provide it as a take home resource). Clinicians in the control group conducted their consultations as usual.Main outcome measures The proportion of children who attended a face-to-face consultation about the same illness during the two week follow-up period. Secondary outcomes included antibiotic prescribing, antibiotic consumption, future consulting intentions, and parental satisfaction, reassurance, and enablement.Results Reconsultation occurred in 12.9% of children in the intervention group and 16.2% in the control group (absolute risk reduction 3.3%, 95% confidence interval-2.7% to 9.3%, P=0.29). Using multilevel modelling (at the practice and individual level) to account for clustering, no significant difference in reconsulting was noted (odds ratio 0.75; 0.41 to 1.38). Antibiotics were prescribed at the index consultation to 19.5% of children in the intervention group and 40.8% of children in the control group (absolute risk reduction 21.3%, 95% confidence interval 13.7 to 28.9), P