In the JournalsPerspective

Novel intervention reduces patient visits tied to respiratory tract infection

A novel, online parent-targeted intervention utilized in England reduced primary care attendance for self-limiting, low-risk respiratory tract infections among children, according to findings recently published in Annals of Family Medicine.

"Respiratory tract infections are one of the main reasons for primary care consultation for children. These consultations contribute to primary care clinicians’ increasing workload and cost the National Health Service £31.5M per year ($39.7M US)," Annegret Schneider, MSc, PhD of the University College in London and colleagues wrote.

"Primary care consultations for respiratory tract infections often lead to unnecessary antibiotic prescribing, promoting anti-microbial resistance. Providing parents with actionable information can reduce the number of unnecessary consultations by up to 40%, can have a significant positive impact on resources, and can promote antimicrobial stewardship," they added.

Researchers randomly assigned 806 mothers to receive an online intervention that combined home-care advice, microbiological local syndromic surveillance information and symptom details before (intervention group) or after (control group) the women answered questions regarding their intent to visit a primary care physician for a respiratory tract infection scenario and mediating factors. The intervention also contained information specifically geared towards parents, repeated important points, categorized information in a structured way, and made instructions brief, simple, specific and supported by visual aids.

Schneider and colleagues found that the mothers’ mean intention score — on a scale of one to 10 — to visit a PCP was 7.29, and the intervention participants reported lower visit intentions (mean score, 6.45) vs. control participants (mean score, 8.12). Similar results occurred when the data were controlled for clinical and demographic characteristics.

Researchers also reported that the intervention seemed most effective when it was indirectly administered, social norms regarding attendance and concerns regarding symptom severity were discussed and antibiotic and infection knowledge was mediated. In addition, some participants described the intervention as an “excellent resource for parents,” “really puts people’s minds at rest” and “easy format.”

Schneider and colleagues added that research into their invention will continue.

“The effectiveness of individual intervention components in changing parents’ behavior requires further research,” they wrote. – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.


A novel, online parent-targeted intervention utilized in England reduced primary care attendance for self-limiting, low-risk respiratory tract infections among children, according to findings recently published in Annals of Family Medicine.

"Respiratory tract infections are one of the main reasons for primary care consultation for children. These consultations contribute to primary care clinicians’ increasing workload and cost the National Health Service £31.5M per year ($39.7M US)," Annegret Schneider, MSc, PhD of the University College in London and colleagues wrote.

"Primary care consultations for respiratory tract infections often lead to unnecessary antibiotic prescribing, promoting anti-microbial resistance. Providing parents with actionable information can reduce the number of unnecessary consultations by up to 40%, can have a significant positive impact on resources, and can promote antimicrobial stewardship," they added.

Researchers randomly assigned 806 mothers to receive an online intervention that combined home-care advice, microbiological local syndromic surveillance information and symptom details before (intervention group) or after (control group) the women answered questions regarding their intent to visit a primary care physician for a respiratory tract infection scenario and mediating factors. The intervention also contained information specifically geared towards parents, repeated important points, categorized information in a structured way, and made instructions brief, simple, specific and supported by visual aids.

Schneider and colleagues found that the mothers’ mean intention score — on a scale of one to 10 — to visit a PCP was 7.29, and the intervention participants reported lower visit intentions (mean score, 6.45) vs. control participants (mean score, 8.12). Similar results occurred when the data were controlled for clinical and demographic characteristics.

Researchers also reported that the intervention seemed most effective when it was indirectly administered, social norms regarding attendance and concerns regarding symptom severity were discussed and antibiotic and infection knowledge was mediated. In addition, some participants described the intervention as an “excellent resource for parents,” “really puts people’s minds at rest” and “easy format.”

Schneider and colleagues added that research into their invention will continue.

“The effectiveness of individual intervention components in changing parents’ behavior requires further research,” they wrote. – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.


    Perspective
    Jeffrey Linder

    Jeffrey Linder

    This study by Schneider et al is interesting but is based on theory and not on actual observed behaviors, and thus hard to know how effective this intervention would be in a real-world primary care setting.

    Educational interventions of primary care physicians have had limited effect as the reasons why antibiotics are still being prescribed in primary care is not a problem of knowledge. Rather than trying to educate, we have had more success addressing the social and emotional factors tied to antibiotic prescribing.

    PCPs need to know that not every single patient who comes into your office with a cold or a sniffle wants an antibiotic. Some do, but we wind up overtreating many patients because we are scarred by the memory of the rare patient who has aggressively insisted on receiving an antibiotic. Most patients are better served — and very satisfied — to learn when it’s time to seek medical attention for the first time with colds and sniffles, and then when is the appropriate time to come back for follow-up.

    • Jeffrey Linder, MD, MPH
    • Chief, Division of general internal medicine and geriatrics
      Department of medicine Northwestern University Feinberg School of Medicine

    Disclosures: Linder reports no relevant disclosures.