Developing a data-enabled nudge intervention for childhood antibiotics in primary care: a qualitative study

Background: Preschool children (aged ≤5 years) have the highest antibiotic prescribing rate in general practice, mostly for self-limiting acute respiratory tract infections (RTIs). Research from >250 000 UK children suggests that a child’s antibiotic history for RTI may be a good predictor for re-consulting a health professional for the same illness episode and increased clinical workload. Aim: To develop a data-enabled nudge intervention to optimise antibiotic prescribing for acute RTI based on a child’s antibiotic history in general practice. Design & setting: Two-phase qualitative study with parents or carers of preschool children and primary care clinicians in England. Method: In phase 1, through an initial focus group with eight parents or carers and ‘think-aloud’ interviews with 11 clinicians, we co-designed the intervention (computer-screen prompt and personalised consultation leaflet). In phase 2, 13 clinicians used the intervention, integrated into the GP computer software, and shared their feedback through ‘think-aloud’ interviews. Interviews were audio-recorded, transcribed, and analysed thematically. Results: We co-created a data-driven intervention that automatically integrates a child’s antibiotic history for acute RTI and personalised leaflet into the electronic medical records. We found that parents and clinicians found this intervention, in principle, acceptable and feasible to use in primary care consultations. GP participants reflected on the prompt’s novelty and its usefulness of taking stock of the number of antibiotic prescriptions a child has had in the past year. Conclusion: Delivering such interventions, integrated into practice workflow, could be efficiently scaled up to promote effective antimicrobial stewardship and reduce unnecessary antibiotic use in primary care. Further research will test this intervention in a future trial.