Management of respiratory tract infections in young children\u2014A qualitative study of primary care providers\u2019 perspectives

Danilla Grando,Ruby Biezen,Bianca Brijnath,Danielle Mazza

doi:10.1038/s41533-017-0018-x

Abstract

Respiratory tract infections in young children are the most common cause of general practice visits in Australia. Despite the availability of clinical practice guidelines, the treatment and management of respiratory tract infections in young children is inconsistent. The aim of the study was to explore the management of respiratory tract infections in young children from a multi-disciplinary perspective using across-sectional qualitative research design based on the theoretical domains framework and the Capability, Opportunity and Motivation-B model. In-depth interviews were conducted with 30 primary care providers to explore their knowledge, views and management of respiratory tract infections in young children. Interviews focused on symptomatic management, over-the-counter medications and antibiotic use, and data were thematically analysed. Our findings showed that factors such as primary care providers’ time constraints, parental anxiety, general practitioners’ perception of what parents want, perceived parental pressure, and fear of losing patients were some of the reasons why primary care providers did not always adhere to guideline recommendations. Primary care providers also provided conflicting advice to parents concerning over-the-counter medications and when children should resume normal activities. Overall, this study showed that complex interactions involving emotional and psychological factors influenced the decision making process of primary care providers’ management of respiratory tract infections in young children. A team care approach with consistent advice, and improved communication between primary care providers and parents is vital to overcome some of these barriers and improve guideline adherence. The findings of this research will inform the development of interventions to better manage respiratory tract infections in young children.

Highlights

Respiratory tract infections (RTIs) are the most frequent reason for general practice presentation in Australia.[1]
Recent US studies have found that factors such as parental misconception regarding the symptoms of RTIs and their understanding of antibiotic use have influenced physicians’ management of RTIs in young children.[9, 10]
Our study applied a systematic approach using the theoretical domain framework (TDF) and Capability, Opportunity and Motivation (COM-B) model to explore primary care providers (PCPs)’ attitudes and practice in managing RTIs in young children. It appears that the management of RTIs is a consultation process involving PCPs and parents of the sick child, many extra-clinical factors such as time constraints on PCP; parental anxiety; general practitioners’ (GPs)’ perception of what parents want; fear of losing patients; and the perception of parental pressures influenced the management and treatment of RTIs in young children

Summary

Introduction

Respiratory tract infections (RTIs) are the most frequent reason for general practice presentation in Australia.[1]. Oral decongestants and cough syrups are no longer recommended for children under the age of six due to the lack of evidence that they are effective and the possibility of side effects in this age group.[4,5,6] As the majority of RTIs are caused by viruses, antibiotics are not warranted as a treatment for most RTIs. Despite available clinical guidelines,[7] general practitioners’ (GPs) treatment and management of RTIs in young children have been shown to be inconsistent in Australia; recent analysis of GP management of RTIs in children

Objectives

Methods

Findings

Conclusion