title: Primary care clinician antibiotic prescribing decisions in consultations for children with RTIs: a qualitative interview study.
abstract: BACKGROUND
  Respiratory tract infections (RTIs) are a major primary care challenge in children because they are common and costly, there is uncertainty regarding their diagnosis, prognosis, and management, and the overuse of antibiotics leads to illness medicalisation and bacterial resistance.
  
  
  OBJECTIVE
  To investigate healthcare professional (HCP) diagnostic and antibiotic prescribing decisions for children with RTIs.
  
  
  METHODS
  Semi-structured interviews conducted with 22 GPs and six nurses. HCPs were recruited from six general practices and one walk-in centre, serving a mix of deprived and affluent areas.
  
  
  METHODS
  Interviews were audiorecorded, transcribed, imported into NVivo 9, and analysed thematically.
  
  
  RESULTS
  HCPs varied in the symptom and clinical examination findings used to identify children they thought might benefit from antibiotics. Their diagnostic reasoning and assessment of perceived clinical need for antibiotics used a dual process, combining an initial rapid assessment with subsequent detailed deductive reasoning. HCPs reported confidence diagnosing and managing most minor and severe RTIs. However, residual prognostic uncertainty, particularly for the intermediate illness severity group, frequently led to antibiotic prescribing to mitigate the perceived risk of subsequent illness deterioration. Some HCPs perceived a need for more paediatrics training to aid treatment decisions. The study also identified a number of non-clinical factors influencing prescribing.
  
  
  CONCLUSIONS
  Prognostic uncertainty remains an important driver of HCPs' antibiotic prescribing. Experience and training in recognising severe RTIs, together with more evidence to help HCPs identify the children at risk of future illness deterioration, may support HCPs' identification of the children most and least likely to benefit from antibiotics.
authors: Centre for Academic Primary Care, NIHR School of Primary Care Research, School of Social and Community Medicine.
authors: Jeremy
authors: J
authors: Horwood
authors: Centre for Academic Primary Care, NIHR School of Primary Care Research, School of Social and Community Medicine.
authors: Christie
authors: C
authors: Cabral
authors: Centre for Academic Primary Care, NIHR School of Primary Care Research, School of Social and Community Medicine.
authors: Alastair D
authors: AD
authors: Hay
authors: Centre for Child and Adolescent Health, Schoolof Social and Community Medicine, University of Bristol, Bristol.
authors: Jenny
authors: J
authors: Ingram
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D036301:Qualitative Research; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012196:Review Literature as Topic; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotics; childhood cough; diagnosis; qualitative research; respiratory tract infections