Online experiment comparing GPs’ antibiotic prescribing decisions to a clinical prediction rule

Martine Nurek, Alastair D Hay, Olga Kostopoulou

Research output: Contribution to journalArticle (Academic Journal)peer-review


Background: The validated “STARWAVe” clinical prediction rule uses seven factors to guide risk assessment and antimicrobial stewardship in children with cough (short illness duration, temperature, age, recession, wheeze, asthma, vomiting). Recently, we manipulated these factors in clinical vignettes to determine their influence on General Practitioners (GPs’) risk assessments and antibiotic prescribing decisions. Relative to STARWAVe, GPs used three factors appropriately (age, wheeze, vomiting) and one inappropriately (short illness duration). The remaining three factors were not investigated (temperature, recession, asthma).

Aim: To assess the influence of all seven STARWAVe factors on GPs’ risk assessments and prescribing decisions. We expect to replicate our previous findings; we have no hypotheses concerning the three factors that were not investigated. We will also vary the method of obtaining risk estimates, to explore its effect on GPs’ responses. Finally, we will test whether parental concern for the child’s wellbeing might increase risk estimates and/or prescribing odds.

Design and setting: Experiment comprising clinical vignettes administered to 180 UK GPs online.

Method: GPs will be randomly assigned to view 32 (of 64) vignettes depicting children with cough. Vignettes will comprise the seven STARWAVe factors, varied in a fractional factorial design. Per vignette, GPs will estimate risk of deterioration in one of two ways (randomly assigned) and indicate whether they would prescribe antibiotics. Finally, GPs will see an additional vignette, suggesting that “the parent is quite concerned”. Using mixed-effects regression, we will measure the influence of STARWAVe factors, risk elicitation method, and parental concern on GPs' estimates and decisions.
Original languageEnglish
JournalBritish Journal of General Practice
Publication statusAccepted/In press - 10 Dec 2020

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