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Understanding the influence of parent-clinician communication on antibiotic prescribing for children with respiratory tract infections in primary care: a qualitative observational study using a conversation analysis approach

BACKGROUND: Acute respiratory tract infections (RTI) in children are a common reason for antibiotic prescribing. Clinicians’ prescribing decisions are influenced by perceived parental expectations for antibiotics, however there is evidence that parents actually prefer to avoid antibiotics. This stud...

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Autores principales: Cabral, Christie, Horwood, Jeremy, Symonds, Jon, Ingram, Jenny, Lucas, Patricia J., Redmond, Niamh M., Kai, Joe, Hay, Alastair D., Barnes, Rebecca K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642577/
https://www.ncbi.nlm.nih.gov/pubmed/31324157
http://dx.doi.org/10.1186/s12875-019-0993-9
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author Cabral, Christie
Horwood, Jeremy
Symonds, Jon
Ingram, Jenny
Lucas, Patricia J.
Redmond, Niamh M.
Kai, Joe
Hay, Alastair D.
Barnes, Rebecca K.
author_facet Cabral, Christie
Horwood, Jeremy
Symonds, Jon
Ingram, Jenny
Lucas, Patricia J.
Redmond, Niamh M.
Kai, Joe
Hay, Alastair D.
Barnes, Rebecca K.
author_sort Cabral, Christie
collection PubMed
description BACKGROUND: Acute respiratory tract infections (RTI) in children are a common reason for antibiotic prescribing. Clinicians’ prescribing decisions are influenced by perceived parental expectations for antibiotics, however there is evidence that parents actually prefer to avoid antibiotics. This study aimed to investigate the influence of parent-clinician communication on antibiotic prescribing for RTI in children in England. METHODS: A mixed methods analysis of videoed primary care consultations for children (under 12 years) with acute cough and RTI. Consultations were video-recorded in six general practices in southern England, selected for socio-economic diversity. 56 recordings were transcribed in detail and a subset of recordings and transcripts used to develop a comprehensive interaction-based coding scheme. The scheme was used to examine communication practices between parents and clinicians and how these related to antibiotic or non-antibiotic treatment strategies. RESULTS: Parents’ communication rarely implied an expectation for antibiotics, some explicitly offering a possible viral diagnosis. Clinicians mostly gave, or implied, a viral diagnosis and mainly recommended non-antibiotic treatment strategies. In the minority of cases where parents’ communication behaviours implied they may be seeking antibiotic treatment, antibiotics were not usually prescribed. Where clinicians did prescribe antibiotics, they voiced concern about symptoms or signs, including chest pain, discoloured phlegm, prolonged fever, abnormal chest sounds, or pink /bulging ear drums. CONCLUSIONS: We found little evidence of a relationship between parents’ communication behaviours and antibiotic prescribing. Rather, where antibiotics were prescribed, this was associated with clinicians’ expressed concerns regarding symptoms and signs.
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spelling pubmed-66425772019-07-29 Understanding the influence of parent-clinician communication on antibiotic prescribing for children with respiratory tract infections in primary care: a qualitative observational study using a conversation analysis approach Cabral, Christie Horwood, Jeremy Symonds, Jon Ingram, Jenny Lucas, Patricia J. Redmond, Niamh M. Kai, Joe Hay, Alastair D. Barnes, Rebecca K. BMC Fam Pract Research Article BACKGROUND: Acute respiratory tract infections (RTI) in children are a common reason for antibiotic prescribing. Clinicians’ prescribing decisions are influenced by perceived parental expectations for antibiotics, however there is evidence that parents actually prefer to avoid antibiotics. This study aimed to investigate the influence of parent-clinician communication on antibiotic prescribing for RTI in children in England. METHODS: A mixed methods analysis of videoed primary care consultations for children (under 12 years) with acute cough and RTI. Consultations were video-recorded in six general practices in southern England, selected for socio-economic diversity. 56 recordings were transcribed in detail and a subset of recordings and transcripts used to develop a comprehensive interaction-based coding scheme. The scheme was used to examine communication practices between parents and clinicians and how these related to antibiotic or non-antibiotic treatment strategies. RESULTS: Parents’ communication rarely implied an expectation for antibiotics, some explicitly offering a possible viral diagnosis. Clinicians mostly gave, or implied, a viral diagnosis and mainly recommended non-antibiotic treatment strategies. In the minority of cases where parents’ communication behaviours implied they may be seeking antibiotic treatment, antibiotics were not usually prescribed. Where clinicians did prescribe antibiotics, they voiced concern about symptoms or signs, including chest pain, discoloured phlegm, prolonged fever, abnormal chest sounds, or pink /bulging ear drums. CONCLUSIONS: We found little evidence of a relationship between parents’ communication behaviours and antibiotic prescribing. Rather, where antibiotics were prescribed, this was associated with clinicians’ expressed concerns regarding symptoms and signs. BioMed Central 2019-07-19 /pmc/articles/PMC6642577/ /pubmed/31324157 http://dx.doi.org/10.1186/s12875-019-0993-9 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Cabral, Christie
Horwood, Jeremy
Symonds, Jon
Ingram, Jenny
Lucas, Patricia J.
Redmond, Niamh M.
Kai, Joe
Hay, Alastair D.
Barnes, Rebecca K.
Understanding the influence of parent-clinician communication on antibiotic prescribing for children with respiratory tract infections in primary care: a qualitative observational study using a conversation analysis approach
title Understanding the influence of parent-clinician communication on antibiotic prescribing for children with respiratory tract infections in primary care: a qualitative observational study using a conversation analysis approach
title_full Understanding the influence of parent-clinician communication on antibiotic prescribing for children with respiratory tract infections in primary care: a qualitative observational study using a conversation analysis approach
title_fullStr Understanding the influence of parent-clinician communication on antibiotic prescribing for children with respiratory tract infections in primary care: a qualitative observational study using a conversation analysis approach
title_full_unstemmed Understanding the influence of parent-clinician communication on antibiotic prescribing for children with respiratory tract infections in primary care: a qualitative observational study using a conversation analysis approach
title_short Understanding the influence of parent-clinician communication on antibiotic prescribing for children with respiratory tract infections in primary care: a qualitative observational study using a conversation analysis approach
title_sort understanding the influence of parent-clinician communication on antibiotic prescribing for children with respiratory tract infections in primary care: a qualitative observational study using a conversation analysis approach
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642577/
https://www.ncbi.nlm.nih.gov/pubmed/31324157
http://dx.doi.org/10.1186/s12875-019-0993-9
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