Qualität in der Primärversorgung Offener Zugang

Abstrakt

Identifying consensus on the appropriate advice for managing common childhood illnesses: a nominal group study

Jane Dyas, Jane Bethea, Margaret Jones

Background Consultation rates in the UK for children aged 0–4 years are high and may be rising due to increased consultations for minor illness. It has been reported that parents lack confidence when making decisions on how to manage common childhood illnesses and that advice received from healthcare professionals is not always consistent.Objective The objective of the studywas to identify advice and information that should be given to parents or carers around the management of common childhood illnesses that is agreed upon by a range of primary healthcare professionals.Methods The nominal group technique was used to identify items of advice that could be given to parents/carers relating to the management of common childhood illness. Forty-eight primary care professionals replied to an open question letter on what clinical advice they gave to parents, how to reduce parental anxieties in the consultation and how best to relay advice outside the consultation. The responses to this survey were developed into a 97-item questionnaire that would form the basis of the nominal group discussion. Two parents and seven primary care professionals were then recruited to take part in the nominal group. Prior to the group session, participants were asked to complete the 97-item questionnaire. Analysis was  done to identify any pre-existing consensus and then a highly facilitated group discussion was held where group members were asked to discuss items where consensus had not been reached. During this discussion the participants re-rated the questionnaireitems, and the analysis to identify consensus was repeated.Results There was a lack of consensus for many of the questionnaire items considered by the group members. Prior to the group discussion, consensus was reached on seven questionnaire items relating to the clinical management of common childhood illness. Following the group discussion, consensus was reached for a further 12. Items where consensus was reached included advice such as: ‘If a child has a sore throat a standard dose of oral paracetamol or ibuprofen should be given as indicated on the bottle’.Conclusion Therewas a lack of consensus on many of the questionnaire items that were discussed by the nominal group members. This may have implications for the consistency and hence quality of advice that is provided by the primary care team around the appropriate management of common childhood illness. It is recommended that primary care teams focus on providing advice on which there was consensus, as a means of generating greater consistency and improving the quality of management of childhood illnesses in primary care.