Clinicians have found the ‘CHIldren with acute COugh’ (CHICO) intervention valuable in supporting decision-making around antibiotic prescribing and facilitating discussions with carers about concerns and treatment options, according to University of Bristol led research published in the British Journal of General Practice.

Childhood respiratory tract infections (RTIs) are common, often leading to unnecessary antibiotic use and contributing to antimicrobial resistance. The qualitative study aimed to explore how clinicians implemented the CHICO intervention, using interviews to understand its acceptability and use.

The intervention had three components:

• GPs asking parents/carers about their concerns during the consultation;
• use of an online algorithm to identify children at very low risk of hospital admission within 30 days of the consultation (in whom antibiotics might be safely withheld); and
• a leaflet for parents and carers explaining what to do should their child’s condition not improve or deteriorate.

Nearly 300 practices across all 15 Clinical Research Networks (CRNs) in England prior and during the pandemic, with both high and low antibiotic dispensing rates, took part.

Key findings

Positive reception: Most clinicians found the CHICO intervention quick and easy to use, assisting in eliciting carer concerns and reassuring both clinicians and carers about the appropriateness of treatment decisions.

Supportive aid: While well-received, clinicians primarily used the algorithm as a supportive aid for treatment decisions rather than a catalyst for behaviour change. The accompanying advice leaflet played a crucial role in explaining treatment decisions and supporting self-care.

Alignment challenges: The intervention did not always align with clinicians’ usual processes, e.g. not all clinicians like to use their computer when with patients, potentially impacting usage. Also, as clinicians become more familiar with the algorithm, they relied less on the intervention and used it less. Reduced intervention use was also exacerbated by changes to practice and remote consultations during the COVID-19 pandemic.

Clare Clement, Research Fellow at the University of the West of England and lead author, said: “In addressing childhood respiratory infections, the CHICO intervention serves as a useful tool for clinicians, aiding in antibiotic prescription decisions and facilitating meaningful conversations with parents and carers. The study highlights the importance of empowering patients with informed choices through the intervention’s advice leaflet, which was perceived positively by clinicians for its role in supporting treatment decisions and providing valuable information to parents.”

The study is part of the larger National Institute for Health and Care Research (NIHR) funded randomised clinical controlled CHICO trial, which found that, while useful for GP clinical decision-making, the CHICO intervention neither reduced overall antibiotic prescribing nor increased hospital admissions. However the leaflet given to carers was well received and helped explain treatment decisions.

Paper: Implementation of the CHIldren with acute COugh (CHICO) intervention to improve antibiotics management: a qualitative study in primary care by Clare Clement, Jenny Ingram, Christie Cabral, Peter S Blair, Alastair D. Hay, Penny Seume and Jeremy Horwood. Published in British Journal of General Practice. April 2024.

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Further information

About the Centre for Academic Primary Care

The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow on Twitter: @capcbristol and on LinkedIn.

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