Centre for Appearance Research, University of the West of England (UWE Bristol), Bristol.
Centre for Academic Child Health, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol.
Br J Gen Pract. 2024 May 30;74(743):e401-e407. doi: 10.3399/BJGP.2023.0330. Print 2024 Jun.
Childhood 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.
To examine the implementation of the CHICO intervention by primary care clinicians.
A qualitative study with primary care clinicians in England taking part in the CHICO randomised controlled trial.
Interviews 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.
Most 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.
Clinicians 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.
儿童呼吸道感染（RTIs）很常见，可能导致不必要的抗生素使用和抗菌药物耐药性。CHIldren with COugh（CHICO）干预措施包含一个以临床医生为重点的算法（STARWAVe），以预测未来的住院风险、引发照顾者的担忧，以及为照顾者提供记录治疗决策和安全网信息的个性化传单。
研究初级保健临床医生实施 CHICO 干预措施的情况。
这是一项在英格兰参与 CHICO 随机对照试验的初级保健临床医生的定性研究。
访谈探讨了 CHICO 干预措施的可接受性和使用情况。从抗生素配药率较高和较低的各种实践中招募了临床医生。规范过程理论为数据收集和主题分析提供了依据。
大多数临床医生喜欢该干预措施，因为它快速、易于使用，有助于引出照顾者的担忧，并让临床医生和照顾者对治疗决策的适当性感到放心。然而，临床医生将其用作治疗决策的支持性辅助工具，而不是行为改变的工具。配套的建议传单有助于解释治疗决策和支持自我护理。该干预措施并不总是符合临床医生的常规流程，这可能会影响使用。对算法的熟悉程度增加导致干预措施的使用减少，而由于实践和远程咨询的改变，在 COVID-19 大流行期间，干预措施的使用进一步减少。
临床医生发现 CHICO 干预措施有助于支持抗生素处方决策，并有助于与照顾者就担忧和治疗决策进行讨论。该干预措施可能需要进行调整，以更好地与临床医生的咨询流程和远程咨询保持一致。
