Document Type

Article

Publication Date

5-9-2018

Identifier

DOI: 10.1136/bmjopen-2017-020981; PMCID: PMC5942422

Abstract

INTRODUCTION: Children with acute respiratory tract infections (ARTIs) are prescribed up to 11.4 million unnecessary antibiotic prescriptions annually. Inadequate parent-provider communication is a chief contributor, yet efforts to reduce overprescribing have only indirectly targeted communication or been impractical. This paper describes our multisite, parallel group, cluster randomised trial comparing two feasible interventions for enhancing parent-provider communication on the rate of inappropriate antibiotic prescribing (primary outcome) and revisits, adverse drug reactions and parent-rated quality of shared decision-making, parent-provider communication and visit satisfaction (secondary outcomes).

METHODS/ANALYSIS: We will attempt to recruit all eligible paediatricians and nurse practitioners (currently 47) at an academic children's hospital and a private practice. Using a 1:1 randomisation, providers will be assigned to a higher intensity education and communication skills or lower intensity education-only intervention and trained accordingly. We will recruit 1600 eligible parent-child dyads. Parents of children ages 1-5 years who present with ARTI symptoms will be managed by providers trained in either the higher or lower intensity intervention. Before their consultation, all parents will complete a baseline survey and view a 90 s gain-framed antibiotic educational video. Parent-child dyads consulting with providers trained in the higher intensity intervention will, in addition, receive a gain-framed antibiotic educational brochure promoting cautious use of antibiotics and rate their interest in receiving an antibiotic which will be shared with their provider before the visit. All parents will complete a postconsultation survey and a 2-week follow-up phone survey. Due to the two-stage nested design (parents nested within providers and clinics), we will employ generalised linear mixed-effect regression models.

ETHICS/DISSEMINATION: Ethical approval was obtained from the Children's Mercy Hospital Pediatric Institutional Review Board (#16060466). Results will be submitted for publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER: NCT03037112; Pre-results.

Journal Title

BMJ Open

Volume

8

Issue

5

First Page

020981

Last Page

020981

MeSH Keywords

Ambulatory Care Facilities; Anti-Bacterial Agents; Child, Preschool; Clinical Protocols; Female; Health Communication; Humans; Inappropriate Prescribing; Infant; Male; Practice Patterns, Physicians'; Primary Health Care; Randomized Controlled Trials as Topic; Research Design; Respiratory Tract Infections

Keywords

Ambulatory Care Facilities; Anti-Bacterial Agents; Health Communication; Inappropriate Prescribing; Primary Health Care; Respiratory Tract Infections

Comments

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

Publisher's Link: https://bmjopen.bmj.com/content/8/5/e020981.long

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