Halls Amy, Van't Hoff Catherine, Little Paul, Verheij Theo, Leydon Geraldine M
Faculty of Medicine, Academic Unit of Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK.
Education Centre, Royal Bournemouth Hospital, Bournemouth, UK.
BMJ Open. 2017 Sep 15;7(9):e015701. doi: 10.1136/bmjopen-2016-015701.
To explore parents' perspectives, concerns and experiences of the management of lower respiratory tract infections (LRTIs) in children in primary care.
Qualitative semistructured interview study.
UK primary care.
23 parents of children aged 6 months to 10 years presenting with LRTI in primary care.
Thematic analysis of semistructured interviews (either in person or by telephone) conducted with parents to explore their experiences and views on their children being prescribed antibiotics for LRTI.
Four major themes were identified and these are perspectives on: (1) infection, (2) antibiotic use, (3) the general practitioner (GP) appointment and (4) decision making around prescribing. Symptomatic relief was a key concern: the most troublesome symptoms were cough, breathing difficulty, fever and malaise. Many parents were reluctant to use self-care medication, tended to support antibiotic use and believed they are effective for symptoms, illness duration and for preventing complications. However, parental expectations varied from a desire for reassurance and advice to an explicit preference for an antibiotic prescription. These preferences were shaped by: (1) the age of the child, with younger children perceived as more vulnerable because of their greater difficulty in communicating, and concerns about rapid deterioration; (2) the perceived severity of the illness; and (3) disruption to daily routine. When there was disagreement with the GP, parents described feeling dismissed, and they were critical of inconsistent prescribing when they reconsult. When agreement between the parent and the doctor featured, parents described a feeling of relief and legitimation for consulting, feeling reassured that the illness did indeed warrant a doctor's attention.
Symptomatic relief is a major concern for parents. Careful exploration of expectations, and eliciting worries about key symptoms and impact on daily life will be needed to help parents understand when a no antibiotic recommendation or delayed antibiotic recommendation is made.
探讨初级保健中家长对儿童下呼吸道感染（LRTIs）管理的看法、担忧及经历。
定性半结构化访谈研究。
英国初级保健机构。
23名6个月至10岁儿童的家长，这些儿童在初级保健机构就诊时被诊断为LRTIs。
对家长进行半结构化访谈（面对面或通过电话），采用主题分析法，以探究他们对孩子因LRTIs而接受抗生素处方的经历和看法。
确定了四个主要主题，分别是关于：（1）感染，（2）抗生素使用，（3）全科医生（GP）预约，以及（4）处方决策。症状缓解是一个关键问题：最困扰人的症状是咳嗽、呼吸困难、发烧和不适。许多家长不愿使用自我护理药物，倾向于支持使用抗生素，并认为抗生素对症状、病程及预防并发症有效。然而，家长的期望各不相同，从希望得到安慰和建议到明确倾向于开具抗生素处方。这些偏好受到以下因素影响：（1）孩子的年龄，年龄较小的孩子因沟通困难被认为更易受伤害，且担心病情迅速恶化；（2）对疾病严重程度的认知；（3）对日常生活的干扰。当与全科医生意见不一致时，家长表示感觉被忽视，且对再次咨询时处方不一致持批评态度。当家长与医生意见一致时，家长表示咨询后有一种解脱感和合理感，放心地认为疾病确实需要医生关注。
症状缓解是家长主要关心的问题。需要仔细探究家长的期望，了解他们对关键症状及对日常生活影响的担忧，以帮助家长理解何时不建议使用抗生素或延迟使用抗生素。
