Implementation of CHIldren with acute COugh (CHICO) intervention to improve antibiotics management: qualitative study.

BACKGROUND:Childhood respiratory tract infections (RTIs) are common and can lead to unnecessary antibiotic use and antimicrobial resistance. The CHIldren with COugh (CHICO) intervention incorporates a clinician focussed algorithm (STARWAVe) to predict future hospitalisation risk, elicitation of carer concerns, and a carer-focussed personalised leaflet recording treatment decisions and safety netting information. AIM:To examine the intervention implementation by clinicians. DESIGN AND SETTING:A qualitative study with primary care clinicians in England taking part in the CHICO randomised controlled trial. METHOD:Interviews explored the intervention's acceptability and use. Clinicians from a range of practices with high and low antibiotic dispensing rates were recruited. Normalisation Process Theory underpinned data collection and thematic analysis. RESULTS:Most clinicians liked the intervention as it was quick and easy to use, it helped elicit carer concerns and reassured clinicians and carers of the appropriateness of treatment decisions. However, clinicians used it as a supportive aid for treatment decisions rather than a tool for behaviour change. The advice leaflet helped explain treatment decisions and support self-care. The intervention did not always align with clinicians' usual processes which could affect usage. Increased familiarisation with the algorithm led to reduced intervention use, which was further reduced due to changes to practice and remote consultation during the COVID-19 pandemic. CONCLUSION:Clinicians found the CHICO intervention useful to support decision-making around antibiotic prescribing and helped discussions with carers about concerns and treatment decisions. The intervention may need to be adapted to align more with clinicians' consultation flow and remote consultations.