Eefje de Bont

Parents’ knowledge, attitudes, and practice in childhood fever: an internet-based survey

BACKGROUND Fever in children is common and mostly caused by self-limiting infections. However, the number of (re)consultations in primary care is high, driven by lack of knowledge and fear among parents. These drivers have only been studied in parents when consulting with their sick child. AIM To study knowledge, attitudes, and practice in childhood fever in parents within the general population. DESIGN AND SETTING Internet-based survey of a sample of 1000 parents from the general population of the Netherlands. METHOD A 26-item cross-sectional survey was conducted of parents with one or more children aged < 5 years. RESULTS Of 625 responders (average age 34.9 years), 63.4% and 43.7% indicated ever visiting their GP or GPs out-of-hours centre with a febrile child, respectively: 88.3% knew the definition of fever (>38°C), 55.2% correctly stated that antibiotics are effective in treating bacterial infections and not viral infections, and 72.0% knew that not every child with a fever needs treatment with antibiotics or paracetamol. When asked to prioritise aspects of a GPs consultation, 53.6% considered physical examination as most important. Obtaining a prescription for antibiotics or antipyretics was considered least important. CONCLUSION Knowledge, attitudes, and practices concerning childhood fever varied among parents with young children. Parents generally expect thorough physical examination and information, but not a prescription for medication (antibiotics or antipyretics) when consulting with a feverish child. GPs must be aware of these expectations as these provide opportunities to enhance consultations in general and prescription strategies in particular.

Patient information leaflets to reduce antibiotic use and reconsultation rates in general practice: a systematic review

Objective Patients’ knowledge and expectations may influence prescription of antibiotics. Therefore, providing evidence-based information on cause of symptoms, self-management and treatment is essential. However, providing information during consultations is challenging. Patient information leaflets could facilitate consultations by increasing patients’ knowledge, decrease unnecessary prescribing of antibiotics and decrease reconsultations for similar illnesses. Our objective was to systematically review effectiveness of information leaflets used for informing patients about common infections during consultations in general practice. Design, setting and participants We systematically searched PubMed/MEDLINE and EMBASE for studies evaluating information leaflets on common infections in general practice. Two reviewers extracted data and assessed article quality. Primary and secondary outcome measures Antibiotic use and reconsultation rates. Results Of 2512 unique records, eight studies were eligible (7 randomised, controlled trials, 1 non-randomised study) accounting for 3407 patients. Study quality varied from reasonable to good. Five studies investigated effects of leaflets during consultations for respiratory tract infections; one concerned conjunctivitis, one urinary tract infections and one gastroenteritis and tonsillitis. Three of four studies presented data on antibiotic use and showed significant reductions of prescriptions in leaflet groups with a relative risk (RR) varying from 0.53 (0.40 to 0.69) to 0.96 (0.83 to 1.11). Effects on reconsultation varied widely. One large study showed lower reconsultation rates (RR 0.70 (0.53 to 0.91), two studies showed no effect, and one study showed increased reconsultation rates (RR 1.53 (1.03 to 2.27)). Studies were too heterogenic to perform a meta-analysis. Conclusions Patient information leaflets during general practitioners consultations for common infections are promising tools to reduce antibiotic prescriptions. Results on reconsultation rates for similar symptoms vary, with a tendency toward fewer reconsultations when patients are provided with a leaflet. Use of information leaflets in cases of common infections should be encouraged. Their contributing role in multifaceted interventions targeting management of common infections in primary care needs to further exploration.

Oral and topical antibiotic prescriptions for children in general practice

Objective Most primary care clinical guidelines recommend restrictive antibiotic use for childhood infections. We investigated antibiotic prescription rates over time for oral and topical antibiotics for children (≤12 years) in the period 2000–2010. Design, setting and patients Longitudinal observational study among children (≤12 years) in a large Dutch general practice database in the period 2000–2010. Main outcome measures Oral and topical antibiotic prescribing rates per year and independent factors influencing antibiotic prescriptions. Results We analysed 108 555 patient-years during 2000–2010. At least one chronic disease was recorded in 15.8% of patient-years, with asthma most commonly registered. In 14.8% of the patient-years at least one antibiotic was prescribed, while 26.3% of these received two or more prescriptions. Young age and chronic disease had a significant effect on antibiotic prescriptions. Prescriptions for oral and topical antibiotics increased 4.9% and 1.8%, respectively, during 2000–2005 (p<0.001). Prescription rates for oral antibiotics decreased 3.3% during 2006–2010 (p<0.001), while topical prescribing rates remained stable. Conclusions One in six children received at least one oral antibiotic prescription per year during 2000–2010. While topical prescription rates steadily increased during 2005–2010 and remained stable during 2006–2010, prescription rates for oral antibiotics increased significantly during the period 2000–2005 and then significantly decreased during the period 2006–2010. As clinical guidelines remained the same over this period, the effects could be contributed to the initiation of the Dutch nationwide pneumococcal vaccination campaign in 2006.

Kinderen met koorts op de HAP

Tijdens een normale dienst op de huisartsenpost (HAP) ziet een huisarts diverse kinderen met koorts. Waarom zien we eigenlijk zoveel kinderen met koorts tijdens de dienst? Waarom krijgen zoveel kinderen antibiotica? En hoe maken we ongeruste ouders zelfredzamer?

Parental knowledge, attitudes and beliefs on fever: a cross-sectional study in Ireland

Objectives Fever is a common symptom of mostly benign illness in young children, yet concerning for parents. The aim of this study was to describe parental knowledge, attitudes and beliefs regarding fever in children aged ≤5 years of age. Design A cross-sectional study using a previously validated questionnaire. Results were analysed using descriptive statistics and multivariable logistic regression. Setting Purposively selected primary schools (n=8) in Cork, Ireland, using a paper-based questionnaire. Data were collected from a cross-sectional internet-based questionnaire with a convenience sample of parents via websites and web pages (n=10) previously identified in an interview study. Participants Parents with at least one child aged ≤5 years were invited to participate in the study. Main outcome measures Parental knowledge, attitudes and beliefs when managing fever in children. Results One thousand one hundred and four parents contributed to this research (121 parents from schools and 983 parents through an online questionnaire). Almost two-thirds of parents (63.1%) identified temperatures at which they define fever that were either below or above the recognised definition of temperature (38°C). Nearly two of every three parents (64.6%) alternate between two fever-reducing medications when managing a child’s fever. Among parents, years of parenting experience, age, sex, educational status or marital status did not predict being able to correctly identify a fever, neither did they predict if the parent alternated between fever-reducing medications. Conclusions Parental knowledge of fever and fever management was found to be deficient which concurs with existing literature. Parental experience and other sociodemographic factors were generally not helpful in identifying parents with high or low levels of knowledge. Resources to help parents when managing a febrile illness need to be introduced to help all parents provide effective care.

Medication management of febrile children: a qualitative study on pharmacy employees’ experiences

Background While fever is mostly self-limiting, antibiotic prescription rates for febrile children are high. Although every parent who receives a prescription visits a pharmacy, we have limited insight into pharmacy employees’ experiences with these parents. Pharmacy employees do however exert an important role in ensuring children receive correct dosages and in advising parents on administration of antibiotics. Objective To describe pharmacists’ and pharmacy assistants’ experiences with parents contacting a pharmacy for their febrile child, and to identify ways of improving medication management of these children. Setting Community pharmacies in the Netherlands. Method A qualitative study including 24 Dutch pharmacy employees was conducted, performing four focus group discussions among pharmacy employees. Analysis was based on constant comparative technique using open and axial coding. Main outcome measure Pharmacy employees’ experiences with parents contacting a pharmacy for their febrile child. Results Three categories were identified: (1) workload and general experience, (2) inconsistent information on antibiotic prescriptions, (3) improving communication and collaboration. Pharmacy employees experienced that dosing errors in antibiotic prescriptions occur frequently and doctors provide inconsistent information on prescriptions. Consequently, they have to contact doctors, resulting in a higher workload for both stakeholders. They believe this can be improved by providing the indication for antibiotics on prescriptions, especially when deviating from standard dosages. Conclusion Pharmacy employees experience a high amount of dosing errors in paediatric antibiotic prescriptions. Providing the indication for antibiotics in febrile children on prescriptions, especially when deviating from standard dosages, can potentially reduce dosage errors and miscommunication between doctors and pharmacy employees.

“How Do You Feel about Antibiotics for This?” A Qualitative Study of Physician Attitudes towards a Context-Rich Communication Skills Method

To explore experiences with and views of general practitioners (GPs) on a physician communication training method in primary care and its applicability and implementation in daily practice, we performed a semi-structured qualitative study of GPs’ experience of training in and implementing a communication skills training program for managing lower respiratory tract infection (LRTI) which included a seminar, simulated patient consultation together with providing and receiving feedback on ones own transcript, and a seminar in a structured approach to the LRTI consultation. Seventeen out of 20 eligible GPs who had participated in the IMPAC3T trial and were allocated to receiving enhanced physician communication training for managing lower respiratory tract infection participated. GPs’ experiences with the physician communication training method and its specific components were positive. The method gave GPs additional tools for managing LRTI consultations and increased their sense of providing evidence-based management. During the study, GPs reported using almost all communication items covered in the training, but some GPs stated that the communication skills diluted over time, and that they continued to use a selected set of the skills. The general communication items were most regularly used. Implementation of the method in daily practice helped GPs to prescribe fewer antibiotics in LRTI with the only perceived disadvantage being time-pressure. This study suggests that GPs felt positive about the physician communication training method for enhanced management of LRTI in primary care. GPs continued to use some of the communication items, of which general communication items were the most common. Furthermore, GPs believed that implementation of the communication skills in daily practice helped them to prescribe fewer antibiotics. The context-rich communication method could have wider application in common conditions in primary care.

Centrale rol huisarts in zorgnetwerk antibioticaresistentie

SamenvattingVergeleken met hun buitenlandse collega’s zijn Nederlandse huisartsen terughoudend in het voorschrijven van antibiotica. Toch neemt het probleem van de antibioticaresistentie ook in onze huisartsenpraktijken toe. Antibioticaresistentie vraagt om een aanpak op meerdere fronten, want er is niet een magische oplossing. Daarom nam de minister van Volksgezondheid, Welzijn en Sport in 2015 het initiatief tot een meerjarenplan voor de aanpak van antibioticaresistentie. Deze aanpak moet onder andere tot de vorming van tien regionale zorgnetwerken leiden, waarin de huisarts een belangrijke rol speelt.

Een uitgesteld antibioticarecept bij luchtweginfecties

SamenvattingEen uitgesteld antibioticarecept bij luchtweginfecties leidt tot minder antibioticagebruik zonder dat er meer complicaties optreden en resulteert in een gelijke patiënttevredenheid. Dat is de conclusie van een Cochrane-review naar het effect van uitgestelde antibioticarecepten bij luchtweginfecties. Alleen géén recept uitschrijven leidt tot nog minder antibioticagebruik.

Minder antibiotice bij luchtweginfecties

CRP- en procalcitoninetests èn gezamenlijke besluitvorming leiden tot een kwart minder antibioticavoorschriften van huisartsen voor patiënten met luchtweginfecties. Dat is de conclusie van deze Cochrane-review, het eerste systematisch vergelijkend overzicht van deze interventies. Dit is belangrijk want om antibioticaresistentie tegen te gaan, moeten (huis)artsen minder antibiotica voorschrijven. Als u morgen uw voorschrijfgedrag bij luchtweginfecties wilt verbeteren, dan laat dit onderzoek zien dat praten en prikken helpt. Patiënten zijn hierdoor niet minder tevreden en komen niet vaker terug.