Improving the care of children with respiratory tract infections

New research aiming to improve the quality of primary care for children with respiratory tract infections has been published by the Bristol NHS Clinical Commissioning Group and the University of Bristol.

The TARGET programme focuses on respiratory tract infections in children as they are the most common problem managed in primary care internationally and present a major issue for health care services.

This is for three main reasons:

1. Respiratory tract infections in children are extremely common and costly to service providers, families, schools and parents’ employers.
2. Clinicians remain uncertain about how to diagnosis and best manage respiratory tract infections in children.
3. Overusing antibiotics can lead to antimicrobial resistance and re-enforces the belief that parents should consult for similar symptoms in the future.

The TARGET programme has found new evidence to help parents, primary care clinicians (doctors and nurses) and policy makers to reduce antibiotic resistance in primary care.

The main findings of the five-year research programme are:

• Symptoms of respiratory tract infections in children last longer than many parents and clinicians expect (some for more than 21 days). Telling families this can help them know what to expect after seeing the doctor or nurse
• An important factor when prescribing antibiotics is clinical uncertainty – clinicians will adopt a “treat just in case” strategy when they are unsure if a child’s condition could get worse (eg need hospitalisation), and they would welcome any evidence that helps them identify which children will get worse.
• Parents value consistent advice from a trusted source, which addresses their common concerns about how to manage their child’s respiratory tract infection, and would value more advice about symptom relief and more precise safety-netting advice.
• Experience and training in recognising severe respiratory tract infections, plus more evidence to identify the children at highest and lowest risk of illness deterioration, may help find those children both most and least likely to benefit from antibiotics.
• The most effective interventions to improve antibiotic use target parents and doctors during consultations; promote clinician leadership in the intervention design; provide automatic prescribing prompts; and employ delayed prescribing.

Professor Alastair Hay, from CAPC at the University of Bristol, led the programme:

“Children with respiratory tract infections often receive antibiotics despite the fact that antibiotics will not help the majority of children’s infections. Our research has uncovered why clinicians prescribe antibiotics; what parents want from a consultation with their GP and what sorts of interventions would help improve the use of antibiotics in primary care. With antimicrobial resistance an ever growing problem, we hope our research will go some way to tackle this issue.”

In response to the research, Dr Stephanie Smith of Royal College of Paediatrics and Child Health (RCPCH), said:

“Antimicrobial resistance poses a real threat to child health so any new research on the issue is very welcome indeed. This study highlights some very important drivers for the prevention of antimicrobial resistance with education being the tool at the forefront. Healthcare professionals need to feel confident in their diagnosis and specialist child health training for general practitioners – who are the first point of call for unwell children – will help address this.”

A guide is available from the University of Bristol which provides information for parents on when to see a GP and how to care for a child with a cough. To access this helpful two page pdf, please click here.

For more information on the TARGET programme at the University of Bristol, please click here.