Review article
Interventions in health care professionals to improve treatment in children with upper respiratory tract infections

https://doi.org/10.1016/j.ijporl.2010.07.008Get rights and content

Abstract

Objective

To analyse which strategies are used to promote evidence based interventions in the management of children with upper respiratory tract infections (URTIs) in daily practice. To assess the effectiveness of these interventions, and when more are effective – which works best. And to analyse the costs associated with these interventions.

Methods

We systematically searched Pubmed, Embase and CENTRAL bibliographies for studies on the effectiveness of strategies aimed at changing health care professionals’ behavior in the management of children with URTIs.

Results

The search yielded 11,788 references, of which 18 studies were eligible, and 10 met the inclusion criteria. Most strategies were aimed at changing antibiotic prescribing behavior in children with acute otitis media. All strategies used (i.e. computer interventions, educational sessions with or without education materials, collaborative development of guidelines and a training video in combination with a risk factor checklist) were effective in changing health care professionals practice regarding children with URTIs. Multifaceted and computer strategies work best. Computer interventions reduced antibiotic prescribing by 4% and 34% and increased guideline compliance by 41%. Educational sessions combined with education materials reduced inappropriate antibiotic prescription by 2% and 17% and increased knowledge of compliance enhancing strategies by 28% and 29%. Collaborative guideline development combined with educational materials reduced inappropriate antibiotic prescription by 24% and 40%. Finally, by a combination of a training video and a risk factor checklist appropriate referrals by the GP to the otolaryngologist increased by 37%. Since the costs associated with the interventions were not explicitly mentioned in the articles, no conclusion on cost-effectiveness can be drawn.

Conclusion

Multifaceted and computer strategies appear to be most effective to put evidence into practice in the area of URTIs in children.

Introduction

Upper respiratory tract infections (URTIs) presenting as common colds, rhinosinusitis, tonsillopharyngitis and otitis media (OM) are the most common diagnosis in children in general practice [1]. Current practice in these children, e.g. watchful waiting vs. antibiotic or surgical treatment, varies strongly between [2], [3], [4] and even within countries [5], despite ample evidence on treatments being available.

Each year, the number of scientific publications on treatment effects in URTIs is increasing, challenging health care professionals to remain up-to-date [6], [7], [8]. Passive dissemination of trial results and meta-analyses, may therefore not reach these professionals [9], nor affect how they manage their patients [10], [11] In general, clinical practice guidelines are issued to this matter. Alternative strategies comprise educational materials, education sessions, audits and feedbacks, reminders and computerized decision support systems. So far, it is unknown whether such strategies have been effective in changing health care professionals’ behavior and reducing inappropriate use of antibiotics and/or surgery in children with URTIs. Besides, various specialties, i.e., general practitioners, pediatricians and otolaryngologists are involved in the care of children with URTIs. We have shown previously that beliefs regarding the effectiveness of surgical interventions vary across these specialties [11], and thus dissemination and implementation of trial results may require a “specialty specific approach”.

Research so far has focused on reducing both inappropriate treatment and selection of antibiotics in acute illnesses in adult or mixed adult/pediatric populations and no superior strategy has been identified [12]. The results of these studies cannot be transferred directly to the pediatric population as in the care of children not only the patient but also its caregivers are involved. We therefore performed a systematic review of studies on the effectiveness of strategies aimed at changing health care professionals’ behavior in the management of children with URTIs. The objectives of this review were: (1) to analyse which strategies are used to promote evidence based interventions in the management of children with URTIs, (2) to assess the effectiveness of these interventions, and when more are effective – which works best, (3) to analyse the costs associated with these interventions.

Section snippets

Search methods for identification of studies

We systematically searched Pubmed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) using the following search terms and their synonyms; implementation, evidence, guideline, upper respiratory tract infection, otitis media, compliance, behavior and children (see also Appendix 1). The last search was performed on 26 February 2009. The references of all retrieved relevant studies were searched for additional trials. No language restrictions were applied.

Eligibility criteria and study selection

Randomized controlled

Search results

The search retrieved 11,787 references, of which 17 studies were eligible. After reading the full-text articles, nine studies were included. From the reference lists one additional, unpublished trial [14] was obtained (Fig. 1).

Quality assessment

Table 1 summarizes the results of the quality assessment. Seven [14], [15], [16], [17], [18], [19], [20] studies were (cluster) randomized controlled trials. Three studies [21], [22], [23] were non-randomized controlled trials or controlled before after studies and

Discussion

This review shows that all dissemination and implementation strategies used, i.e. computer interventions, educational sessions with or without education materials, collaborative development of guidelines and a training video in combination with a risk factor checklist, are effective in changing health care professionals’ management in children with URTIs.

To our knowledge, we are the first to report on current evidence on dissemination and implementation strategies regarding treatment of URTIs

Conflict of interest

None of the authors has any conflict of interest regarding this paper, and the project was not funded by any grant.

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