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Title: "What's it gonna change?" : real-time paediatric respiratory infection community surveillance : a qualitative interview study of clinicians' perspectives on the use, design and potential impact of a planned intervention
Author: Anderson, Emma C.
ISNI:       0000 0004 6351 3890
Awarding Body: University of the West of England
Current Institution: University of the West of England, Bristol
Date of Award: 2016
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Objectives: The aim of this study is to inform the design and development of an online surveillance intervention, which could have a role in improving the management of paediatric respiratory tract infections (RTI) in primary care, including aiding antimicrobial stewardship. The specific objectives are to assess the perceived utility of the intervention in principle, the potential impact in practice, and clinician preferences for the design, content and mode of delivery, identifying barriers and facilitators to intervention use. Methods: Semi-structured one-to-one interviews were conducted with 21 clinicians (18 GPs; 3 Nurse Practitioners) representing a range of clinical experience from a range of Bristol GP surgeries (deprivation deciles 1 to 9). Interviews explored clinicians’ current approaches to managing paediatric RTIs, knowledge of circulating infections, and views of a mock-up example of local viral and syndromic surveillance information. Interviews were audio recorded, transcribed verbatim and analysed using the framework method. Results: Clinicians agreed there is currently no formal primary care system for identifying circulating infections, and the surveillance information was novel and potentially useful. While symptom duration was perceived as useful, there were mixed responses regarding the use and relevance of knowing community viral microbiology. Barriers identified include time pressures, information overload and lack of fit with clinicians’ perceived role as assessing each child as an individual and looking for risk. Clinicians tended to see a role for the intervention to aid patient explanations. Conclusions: Whilst clinicians viewed the information as potentially beneficial for supporting consultations with parents, there were mixed responses to how knowledge of viral microbiology could or should inform their practice of treating each patient individually, with fear of missing the sick child as a key consideration. While some saw a use for the intervention in aiding decision-making, many only wanted information about risks to look for. There was a sense that current practice does not need to change, and that epidemiological information is not used as a starting point for decision-making in this context. The findings have implications for intervention development (which will draw closely on the results), and more broadly for the field of medical decision-making.
Supervisor: Not available Sponsor: National Institute for Health Research, Health Protection Research Unit (NIHR HPRU) on Evaluation of Interventions ; University of Bristol
Qualification Name: Thesis (D.Health Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available