Article
An illness-focussed interactive booklet to optimise management and medication for childhood fever and infections in out-of-hours general practice: a cluster randomised trial
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Authors
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E. de Bont
- Maastricht University, CAPHRI, Family Medicine, Maastricht, Niederlande
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G. Dinant
- Maastricht University, CAPHRI, Family Medicine, Maastricht, Niederlande
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G. Elshout
- Erasmus MC University Medical Center Rotterdam, Family Medicine, Rotterdam, Niederlande
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G. van Well
- Maastricht University Medical Center (MUMC+), Department of Paediatrics, Maastricht, Niederlande
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N. Francis
- Cardiff University, Division of Population Medicine, School of Medicine, Cardiff, Vereinigtes Königreich
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B. Winkens
- Maastricht University, CAPHRI, Department of Methodology and Statistics, Maastricht, Niederlande
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J. Cals
- Maastricht University, CAPHRI, Family Medicine, Maastricht, Niederlande
| Published: | September 5, 2017 |
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Outline
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Background: Fever in children is common and most often caused by self-limiting infections. However, antibiotic prescriptions remain high.
Question: What is the effect of an illness-focussed interactive booklet on management antibiotic prescriptions, (intention to) (re-)consultations, parental satisfaction, and self-reported adverse events) of children presenting with fever at out-of-hours general practice?
Method: A multicentre, two armed cluster RCT at 20 GP out-of-hours centres among children <12 years with fever. GPs working at intervention sites had access to an illness-focussed interactive booklet. Statistical analysis was based on intention to treat principle using multilevel analyses.
Results: 25355 Children were included by 3518 GPs. 25.4% of children in the control group received antibiotics. GP use of the booklet reduced antibiotic prescribing during index consultation (OR 0.83, 95% CI 0.74-0.94, 3.3% reduction, ICC 0.002) and 2-week follow-up (OR 0.85, 95%CI 0.75-0.96). The booklet was handed out in 28.5% (3407/11945) of the consultations in the access to booklet group. GP access to booklet did not result in a significant difference in antibiotic prescriptions (OR 0.89, 95%CI 0.79-1.02). Children managed by GPs with access to the booklet and actual use of the booklet were less likely to receive any drug prescription. Parents who consulted a GP with access to the booklet showed a reduced intention to reconsult (OR 0.55, 95% CI 0.35-0.85, 8.8% reduction).
Discussion: GP use of an illness-focussed interactive booklet in fever-related consultations in out-of-hours general practice reduces antibiotic prescribing and overall medication prescriptions, without affecting satisfaction with care and parents being less inclined to consult for future similar illnesses.
