A systematic review of parent and clinician views and perceptions that influence prescribing decisions in relation to acute childhood infections in primary care

Abstract

Objectives. To investigate the views of parents, clinicians, and children pertaining to prescribing decisions for acute childhood infection in primary care. Methods. A systematic review of qualitative studies. Meta-ethnographic methods were used, with data drawn from the primary studies in an interpretive analysis. Results. A total of 15 studies met the inclusion criteria. The literature was dominated by concerns about antibiotic over-prescription. Children's views were not reported. Clinicians prescribed antibiotics when they felt pressured by parents or others (e.g. employers) to do so, when they believed there was a clear clinical indication, but also when they felt uncertain of clinical or social outcomes they prescribed “just in case”. Parents wanted antibiotics when they felt they would improve the current illness, and when they felt pressure from daycare providers or employers. Clinicians avoided antibiotics when they were concerned about adverse reactions or drug resistance, when certain they were not indicated, and when there was no perceived pressure from parents. Parents also wished to avoid adverse effects of antibiotics, and did not want antibiotics when they would not relieve current symptoms. Some parents preferred to avoid medication altogether. Within paediatric consultations, parents sought a medical evaluation and decision. Primary care clinicians want satisfied parents and short consultations. Conclusions. Antibiotic prescriptions for childhood infections in primary care often result from “just in case” prescribing. These findings suggest that interventions which reduce clinician uncertainty regarding social or clinical outcomes and provide strategies to meet parents’ needs within a short consultation are most likely to reduce antibiotic prescribing.

Key Words::

• Anti-bacterial agents
• child
• general practice
• primary health care
• qualitative research
• systematic review
• United Kingdom

Acknowledgements

This paper summarizes independent research funded by the National Institute for Health Research (NIHR) under its Programme Grant for Applied Research (Grant Reference Number RP-PG-0608-10018). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

The authors would like to thank all authors of studies included in this review, Jo Abbot for assistance with database searches, and Debbie Allnock and Audrey Leonel for assistance with data extraction and translation.

This research on which this paper is based is part of the TARGET programme. The authors would like to thank the whole team, all have whom contribute to the research programme. The TARGET team consists of: Alastair D. Hay, Andrew Lovering, Brendan Delaney, Christie Cabral, Hannah Christensen, Hannah Thornton, Jenny Ingram, Jeremy Horwood, John Leeming, Margaret Fletcher, Matthew Thompson, Niamh Redmond, Patricia Lucas, Paul Little, Peter Blair, Peter Brindle, Peter Muir, Sandra Hollinghurst, Sue Mulvenna, Talley Andrews, and Tim Peters.

Declaration of interest

There are no conflicts of interest in connection with the paper. The authors alone are responsible for the content and writing of the paper.

Supplementary material available online

Supplemental File to be found online at http://informahealthcare.com/doi/abs/10.3109/02813432.2015.1001942.