Helping parents of children with respiratory infections decide when to seek medical help: an appropriateness study

Talk Code: 
Louise Newbould
Newbould L, Campbell S, Edwards, Morris RL, Hughes E, Hayward G, Hay AD
Author institutions: 
Social Policy Research Unit, University of York; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK.; Nuffield Department of Primary Care Health Sciences, University of Oxford; Manchester University NHS Foundation Trust; Centre of Academic Primary Care, University of Bristol.


Meeting demand for care is a challenge for primary care services internationally. Respiratory tract infections (RTI’s) in children are the most common problem managed, and the most frequent reason for antibiotics to be prescribed. Parents report they are often unsure if and when to seek help, and that existing guidance is unclear. Our research addresses this key issue, as far as we are aware, for the first time worldwide.AimTo develop appropriateness criteria to support parental decision making regarding the appropriate next step and when to consult GP/A&E/999 and when to self-care


The UCLA/RAND method was applied in two-stages. A panel of experts (pharmacists, NHS 111 nurses, GPs and Children’s A&E Consultants) rated 1,134, first on their own and then as part of an expert workshop, to see if a consensus could be achieved on the appropriate ‘next step’


Panellists reached a consensus in 755 (66.58%) scenarios. Of these 6 (0.53%) were rated with disagreement and 383 (33.77%) with an equivocal rating. Of those where agreement was obtained, an appropriate next step was identified in 449 (39.59 %) scenarios. Increasing numbers of symptoms were generally associated with escalation of care from self-care to NHS111/GP to ED/999. In addition, past medical history of hospital admission for asthma, bronchiolitis or other respiratory condition had a nominal impact on panel ratings, though the threshold for the appropriateness of accessing services generally increased with a child aged over 12 years. Informed use of self-care including, pharmacy services, is often appropriate for normal symptoms of RTI of several days duration in children, with guidance for parents on when to consider using primary care or emergency services having the potential to optimise appropriate care options.


Clinicians and policy makers may wish to use promote these criteria to parents to help inform healthcare seeking decision making. In an age where any symptom may be regarded as abnormal and therefore requiring treatment, perhaps in part explaining the rising demand for care, these criteria could be considered useful to distinguish ‘normal’ from ‘abnormal’ infections.

Submitted by: 
Louise Newbould
Funding acknowledgement: 
NIHR School of Primary Care Research grant number 417 GH and GE are funded by the NIHR Community Healthcare Medtech and IVD Cooperative. The views expressed are of the authors and not of the Department of Health and Social Care