An interactive booklet can help reduce the inappropriate use of antibiotics in children with fever. Researchers from UMC Utrecht, Maastricht University, LUMC and Erasmus MC are working together to improve an existing booklet so that it better meets the needs of all parents, including those with, for example, limited health literacy.
Fever is one of the most common reasons why young children visit a general practitioner (GP). Sometimes these children are being prescribed antibiotics, although this is often not necessary. This increases the risk that bacteria will ‘get used’ to a particular antibiotic (this is called antibiotic resistance) and eventually that it may no longer work properly. There is also a risk that a child may suffer unnecessary side effects from the antibiotic. Therefore, it is important to pay attention to the communication between GPs and parents of young children with fever in order to be able to make informed decisions on the appropriate use of antibiotics.
To achieve appropriate antibiotic use, researchers from the Care and Public Health Research Institute (CAPHRI) at Maastricht University developed and evaluated the booklet ‘Children with Fever’ in 2015, which can be found on Thuisarts.nl. This interactive booklet is designed to help parents make informed decisions together with their GP, and it provides advice on what parents can do themselves. In general, the booklet works well and can result in fewer antibiotic prescriptions, but in daily practice it does not appear to be equally appropriate for all parents. Especially with parents with limited health literacy or with an immigrant background, GPs sometimes find it difficult to communicate effectively about the need for an antibiotic prescription. In some cases an antibiotic is prescribed in cases when it could potentially be avoided. For example, in situations where a child most likely suffers from a viral infection and antibiotics thus do not work. The new research focuses on improving the existing booklet and the way it is used.
Researchers are conducting the study with GP practices, in coordination with youth health care and out-of-hours offices. The study has three main goals to improve the use of the booklet:
The researchers expect that an improved version of the booklet:
General practitioner and scientist Alma van de Pol, MD PhD from the Department of General Practice and Nursing Science at UMC Utrecht, principal investigator of the study, emphasizes, “By collaborating nationwide from the start, we increase the chance of an implementation strategy that will be successful on a large scale. With our study, we want to contribute to a better use of antibiotics in general practice in children with fever to reduce the risk of developing antibiotic resistance.”
A research project funded by ZonMw, in which researchers from UMC Utrecht, Maastricht University, LUMC and Erasmus MC collaborate, has been launched under the banner of the UNH-Consortium Research in General Practice (UNH-COH). The aim of the project is to better tailor the implementation of the booklet to this target group. The research is done together with the Dutch College of General Practitioners (NHG), Thuisarts.nl, the national expertise center against health inequalities Pharos, and parents from varying backgrounds.
To prevent antibiotic resistance, antibiotic use should be carefully monitored and prescribed only in specific cases or when a patient is at increased risk of becoming seriously ill. Fever is the main reason for GP visits in children 5 years and younger and a major reason for prescribing antibiotics. However, fever in children usually results from a viral infection, where antibiotics do not work. In a previous survey, 20-40 percent of parents reported that they had taken their child to the GP at least once in the past year because of fever. For the Netherlands, this would amount to about 230,000 GP visits annually, with about 1 in 4 children being prescribed an antibiotic. In addition to putting a child with a fever at risk of avoidable side effects, it also promotes the emergence of antibiotic resistance.
By collaborating nationwide, the researchers hope to develop an approach for the improved booklet that works even better and can be used by all GPs. This project thus contributes to improve general practice and helps health care providers to provide appropriate education about treating children with fever.
