Understanding the influence of parent-clinician communication on antibiotic prescribing for children with respiratory tract infections in primary care: a qualitative observational study using a conversation analysis approach

Christie Cabral,Joe Kai,Rebecca K Barnes,Jenny Ingram,Jon Symonds,Niamh M Redmond,Jeremy Horwood,Patricia J Lucas,Alastair D Hay

doi:10.1186/s12875-019-0993-9

Abstract

BackgroundAcute respiratory tract infections (RTI) in children are a common reason for antibiotic prescribing. Clinicians’ prescribing decisions are influenced by perceived parental expectations for antibiotics, however there is evidence that parents actually prefer to avoid antibiotics. This study aimed to investigate the influence of parent-clinician communication on antibiotic prescribing for RTI in children in England.MethodsA mixed methods analysis of videoed primary care consultations for children (under 12 years) with acute cough and RTI. Consultations were video-recorded in six general practices in southern England, selected for socio-economic diversity. 56 recordings were transcribed in detail and a subset of recordings and transcripts used to develop a comprehensive interaction-based coding scheme. The scheme was used to examine communication practices between parents and clinicians and how these related to antibiotic or non-antibiotic treatment strategies.ResultsParents’ communication rarely implied an expectation for antibiotics, some explicitly offering a possible viral diagnosis. Clinicians mostly gave, or implied, a viral diagnosis and mainly recommended non-antibiotic treatment strategies. In the minority of cases where parents’ communication behaviours implied they may be seeking antibiotic treatment, antibiotics were not usually prescribed. Where clinicians did prescribe antibiotics, they voiced concern about symptoms or signs, including chest pain, discoloured phlegm, prolonged fever, abnormal chest sounds, or pink /bulging ear drums.ConclusionsWe found little evidence of a relationship between parents’ communication behaviours and antibiotic prescribing. Rather, where antibiotics were prescribed, this was associated with clinicians’ expressed concerns regarding symptoms and signs.

Highlights

Acute respiratory tract infections (RTI) in children are a common reason for antibiotic prescribing
Parents may suggest a possible diagnosis (e.g. “strep throat”) or symptoms (e.g. “chesty cough”) that could indicate a need for antibiotic treatment and lead clinicians to perceive parental antibiotic expectations [15, 17], which in turn is associated with higher antibiotic prescribing [12, 18]
Our study aims to build on this earlier work by examining whether these same parental communication patterns can be found in primary care consultations for children with RTI in the UK, and whether they are associated with antibiotic prescribing

Summary

Introduction

Acute respiratory tract infections (RTI) in children are a common reason for antibiotic prescribing. There are multiple influences on the decision to prescribe antibiotics, including clinicians’ interpretation of the clinical signs [7, 8], concern for the safety of the child [9, 10] and perceived pressure from parents [11, 12]. Another key influence on whether antibiotics are prescribed is communication between clinicians and patients or carers [13, 14]. Parents may suggest a possible diagnosis (e.g. “strep throat”) or symptoms (e.g. “chesty cough”) that could indicate a need for antibiotic treatment and lead clinicians to perceive parental antibiotic expectations [15, 17], which in turn is associated with higher antibiotic prescribing [12, 18]

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