CHICO: A clinical effectiveness investigation of a multi-faceted intervention to improve management of antibiotics for CHIldren presenting to primary care with acute COugh and respiratory tract infection


National Institute for Health (NIHR) Health Technology Assessment (HTA) Ref. 16/31/98

What is the research question?

Does the CHICO intervention decrease the number of antibiotic items dispensed for respiratory tract infections to children presenting with acute cough and respiratory tract infection to primary care? Does the intervention alter hospital admissions?

What is the problem?

Respiratory tract infections are the most common reason that children are taken to primary care and are often prescribed antibiotics ‘just in case’, leading to concerns about over-prescribing of antibiotics and antibiotic resistance.

What is the aim of the research?

Previously, we developed an intervention that helped clinicians to know which children are very unlikely to benefit from an antibiotic. We wish to see if using a scoring system, listening to parents’ concerns and giving them a personalised leaflet with care and safety advice, reduces the number of antibiotics collected by parents at pharmacies.

How will this be achieved?

We aim to get all clinicians in a group of practices to use the intervention for all children with cough or RTI. We will compare with another group of practices where the clinicians are providing usual care.

We will use the data collected by the NHS to work out if antibiotic prescribing levels are different between these groups, while hospitalisation rates stay the same. . We will also look if there are any differences in dispensing rates between GPs and nurses and in different ages of the children.

We will use ‘practice champions’ (individual pharmacists or clinicians at each practice) in the intervention group to encourage its use and feedback how well they are doing during the study. We will also embed the intervention within the computer systems already used at each practice for ease of access.

Who is leading the research?

Dr Peter Blair, Reader in Medical Statistics, Population Health Sciences, University of Bristol.

Further information:


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The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.