Real-time paediatric respiratory tract infection (RTI) community surveillance: A qualitative interview study of clinicians’ perspectives on the use, design and potential impact of a planned intervention

Rationale Over-prescription of antibiotics in primary care is a contributor to burgeoning problem of antimicrobial resistance. Children with respiratory tract infections (RTI) represent a substantial proportion of primary care consultations and antibiotic prescribing. An online intervention presenting locally-relevant real-time paediatric RTI (syndromic and virology) surveillance data is planned with an intention of improving the care of children with RTIs – potentially by reducing diagnostic uncertainty and enhancing patient explanation - which could help reduce unnecessary antibiotic prescribing. Aims The aim of this study is to inform the development of the proposed intervention by exploring clinicians’ perspectives on: 1) the use, value and potential impact in practice of a surveillance intervention 2) barriers and facilitator to intervention use, including preferences for intervention content, design and delivery 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 viral and syndromic surveillance information - including information on normal symptom duration. Analysis 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. There were mixed responses to the potential use and impact of the intervention, both across and within interviews. While some support was evident for the intended effects of the intervention (reducing diagnostic uncertainty and subsequently antibiotic prescribing), many clinicians queried the relevance of knowing community viral microbiology, reporting their role as to identify the truly sick (requiring treatment) amidst general ‘viruses going around’, and to treat each child individually (independently of group data). Clinicians expressed a preference for risk-related information or changes to look out for, rather than general epidemiological information. The clinical backdrop of fear of missing the sick child was a prominent theme. Perceived intervention benefits included enhancing patient explanations/expectation management more than decision-making, and symptom duration was perceived as particularly useful in this context. Barriers identified included time pressures, information overload and lack of fit with perceived role of clinician. Design and delivery preferences were for the information to be easily accessible. Conclusions Complex, mixed responses were elicited from clinicians to the provision of online paediatric respiratory infection microbiological and symptomatic surveillance information in terms of perceived use, utility and impact in practice. Whilst clinicians viewed the information as beneficial for supporting consultations with parents, they questioned how knowledge of viral microbiology could or should inform their practice of treating each patient individually. Intervention development will ensure it takes account of time pressures and information overload and clinicians’ preferences for risk information.