Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomised controlled trial Educational interventions to alter pediatric emergency department utilization patterns. A randomized controlled trial on the effect of an information booklet for young families in Denmark. Fever education: Does it reduce parent fever anxiety? Field trials of the Baby Check score card: mothers scoring their babies at home. Feasibility of web-based self-triage by parents of children with influenza-like illness: a cautionary tale. Randomised controlled trial of effect of Baby Check on use of health services in first 6 months of life Standardized instructions: do they improve communication of discharge information from the emergency department? Making choices: why parents present to the emergency department for non-urgent care A study of parent/grandparent education for managing a febrile illness using the CALM approach. Minor illness education for parents of young children. A reduction in emergency department use by children from a parent educational intervention. Effectiveness of Fever Education in a Pediatric Emergency Department Development and randomized controlled trial of a booklet of advice for parents. Mothers' clinical judgment: a randomized trial of the Acute Illness Observation Scales. Can effective parent education occur during emergency room visits?
Objective To establish whether an interactive booklet on  respiratory tract infections in children reduces reconsultation for the same illness episode , reduces antibiotic use , and affects future consulting intentions , while maintaining parental satisfaction with care . Design Pragmatic cluster r and omised controlled trial . Setting 61 general practice s in Wales and Engl and . Participants 558 children ( 6 months to 14 years ) presenting to primary care with an acute respiratory tract infection ( 7 days or less ) . Children with suspected pneumonia , asthma or a serious concomitant illness , or needing immediate hospital admission were excluded . Three withdrew and 27 were lost to follow-up , leaving 528 ( 94.6 % ) with main outcome data . Interventions Clinicians in the intervention group were trained in the use of an interactive booklet on respiratory tract infections and asked to use the booklet during consultations with recruited patients ( and provide it as a take home re source ) . Clinicians in the control group conducted their consultations as usual . Main outcome measures The proportion of children who attended a face-to-face consultation about the same illness during the two week follow-up period . Secondary outcomes included antibiotic prescribing , antibiotic consumption , future consulting intentions , and parental satisfaction , reassurance , and enablement . Results Reconsultation occurred in 12.9 % of children in the intervention group and 16.2 % in the control group ( absolute risk reduction 3.3 % , 95 % confidence interval −2.7 % to 9.3 % , P=0.29 ) . Using multilevel modelling ( at the practice and individual level ) to account for clustering , no significant difference in reconsulting was noted ( odds ratio 0.75 ; 0.41 to 1.38 ) . Antibiotics were prescribed at the index consultation to 19.5 % of children in the intervention group and 40.8 % of children in the control group ( absolute risk reduction 21.3 % , 95 % confidence interval 13.7 to 28.9 ) , P<0.001 ) . A significant difference was still present after adjusting for clustering ( odds ratio 0.29 ; 0.14 to 0.60 ) . There was also a significant difference in the proportion of parents who said they would consult in the future if their child developed a similar illness ( odds ratio 0.34 ; 0.20 to 0.57 ) . Satisfaction , reassurance , and parental enablement scores were not significantly different between the two groups . Conclusions Use of a booklet on respiratory tract infections in children within primary care consultations led to important reductions in antibiotic prescribing and reduced intention to consult without reducing satisfaction with care . Trial registration Current Controlled Trials IS RCT OBJECTIVE To test the hypothesis that educating parents about use of their primary care provider and providing information about common pediatric illnesses will reduce visits to the pediatric emergency department ( PED ) . DESIGN Prospect i ve , r and omized , controlled trial conducted from September 1 , 1993 , to October 31 , 1994 . SETTING Pediatric emergency department of an urban university hospital . PARTICIPANTS Parents of 130 patients seen in the PED for minor illness . INTERVENTIONS Subjects were r and omized to intervention or control groups . Parents in both groups were interviewed about their child 's health and use of health care services . The intervention group received education on pediatric health care issues ; the control group received usual PED discharge instructions . Use of the PED by all subjects was tracked for 6 months by telephone follow-up and medical record review . MAIN OUTCOME MEASURES Differences between the two groups in total number of return visits to the PED and return visits to the PED for minor illness . RESULTS Sixty-seven ( 97 % ) of the 69 patients in the intervention group and 56 ( 92 % ) of the 61 patients in the control group identified a primary care provider . At 6-month follow-up , 21 patients ( 30 % ) from the intervention group and 16 ( 26 % ) from the control group had returned to the PED ( P = .68 , chi 2 ) . Seventeen ( 81 % ) of intervention group returnees to the PED had minor illness , as did 11 ( 69 % ) of control group returnees . CONCLUSIONS A one-time educational intervention in the PED does not alter long-term emergency department utilization habits . More extensive education and greater availability of primary care providers may be needed to decrease use of the PED  for minor illness The aim of the study was to describe young families ' illness-behavior in connection with minor illness in children aged 0 - 8 years , and to assess the effect of delivered written health education . The effectiveness of written health education  in the management of minor illness was evaluated by a r and omized controlled trial . One hundred young families from one group practice were allocated at r and om to a study group and a control group . The study group received written health education . Health education result ed in more self-treatment and fewer contacts with the general practitioner ( GP ) , and the families indicated worry less often as the main reason for consulting the GP . The GPs ' assessment of the appropriateness of the families ' consultations showed no significant differences between the study and the control groups . It is recommended that GPs , in connection with prophylactic child examinations , h and over a patient education manual . This manual could form the basis for a dialogue between the GP and the parents when their child becomes ill Objective The aims of the study were to determine the following : 1 ) if a fever education program ( interactive or written ) reduces parent fever anxiety ; 2 ) if an interactive fever program was more effective as a teaching style than st and ard written material alone ; and 3 ) if a fever program increases parent fever home management and reduces return emergency department ( ED ) visits . Method A quasiexperimental , pretest and post-test pilot study examining parental fever anxiety was conducted at The Children ’s Hospital of Philadelphia . Eligible participants consisted of 87 parents and their children , aged 3 months to 5 years presenting with fever > 38.4 ° C , and without coexisting serious illness . Results Both the interactive fever education program and the st and ard written fever pamphlet were equally effective as teaching methods . Data revealed a 30 % reduction in fever anxiety rated as moderate-severe on arrival to none-low post-fever education , increased parent fever home management skills with correct use of thermometer and antipyretics , and reduced unnecessary return ED visits . Conclusion Parents in the acute and nonacute care setting may benefit from an interactive fever education program that includes the definition and benefit of fever , the correct use of a thermometer , fever home management skills , and appropriate fever telephone follow-up The Baby Check score card has been developed to help parents and health professionals grade the severity of acute illness in babies . This paper reports the results of two field trials in which mothers used Baby Check at home , 104 mothers scoring their babies daily for a week and 56 using it for six months . They all found Baby Check easy to use , between 68 % and 81 % found it useful , and 96 % would recommended it to others . Over 70 % of those using it daily used it very competently . Those using it infrequently did less well , suggesting that familiarity with the assessment is important . The scores obtained show that Baby Check 's use would not increase the number of mothers seeking medical advice . With introduction and practice most mothers should be able to use Baby Check effectively . It should help them assess their babies ' illnesses and make appropriate decisions about seeking medical advice IMPORTANCE Self-triage using web-based decision support could be a useful way to encourage appropriate care-seeking behavior and reduce health system surge in epidemics . However , the feasibility and safety of this strategy have not previously been evaluated . OBJECTIVE To assess the usability and safety of Strategy for Off-site Rapid Triage ( SORT ) for Kids , a web-based decision support tool design ed to translate clinical guidance developed by the Centers for Disease Control and Prevention to help parents and adult caregivers determine if a child with influenza-like illness requires immediate care in an emergency department ( ED ) . DESIGN Prospect i ve pilot validation study conducted between February 8 and April 30 , 2012 . Staff who abstract ed medical records and made follow-up calls were blinded to the SORT algorithm 's assessment of the child 's level of risk . SETTING Two pediatric emergency departments in the National Capital Region . PARTICIPANTS Convenience sample of 294 parents and adult caregivers who were at least 18 years of age ; able to read and speak English ; and the parent or legal guardian of a child 18 years or younger presenting to 1 of 2 EDs with signs and symptoms meeting Centers for Disease Control and Prevention criteria for influenza-like illness . INTERVENTION Completion of the SORT for Kids survey . MAIN OUTCOME MEASURES Caregiver ratings of the website 's usability and the sensitivity of the underlying algorithm for identifying children who required immediate ED management of influenza-like illness , defined as receipt of 1 or more of 5 essential clinical services . RESULTS Ninety percent of participants reported that the website was " very easy " to underst and and use . Ratings did not differ by respondent race , ethnicity , or educational attainment . Of the 15 patients whose initial ED visit met explicit criteria for clinical necessity , the Centers for Disease Control and Prevention algorithm classified 14 as high risk , result ing in an overall sensitivity of 93.3 % ( exact 95 % CI , 68.1%-99.8 % ) . Specificity of the algorithm was poor . CONCLUSIONS AND RELEVANCE This pilot study suggests that web-based decision support to help parents and adult caregivers self-triage children with influenza-like illness is feasible . However , prospect i ve refinement of the clinical algorithm is needed to improve its specificity without compromising patient safety Abstract Objective : To evaluate the effect of Baby Check , an illness scoring system for babies of 6 months or less , on parents ' use of health services for their baby . Design : R and omised controlled trial . Setting : 13 general practice s in Glasgow . Subjects : 997 newly delivered mothers , r and omised to receive either Baby Check and Play It Safe , an accident prevention leaflet ( n=497 ) , or Play It Safealone ( control group , n=500 ) . Main outcome measures : Data on consultations and referrals extracted from general practice notes after 6 months . Results : At the time of recruitment , maternal characteristics were similar for both groups ( mean maternal age 29 years ; deprivation categories 6 and 1 in both groups ; 424 ( 45 % ) mothers were primiparous ) . At 6 months , general practice notes were available for 467 ( 94 % ) of the Baby Check group and 468 ( 94 % ) of the control group . The number of general practitioner consultations did not differ between the groups : median number of consultations was 2 ( interquartile range 1 to 4 ) in the Baby Check group , and 2 ( 1 to 3 ) in the control group . Use of out of hours services did not differ significantly between the two groups ( 86 v 85 ; P=0.93 ) . Conclusion : Distributing Baby Check to an unselected group of mothers does not affect use of health services for infants up to 6 months of age To determine whether st and ardized instructions enhance communication of discharge information , we provided 197 parents of children in whom otitis media was diagnosed with one of three types of instruction at the time of discharge from a pediatric emergency department : ( 1 ) instruction by individual housestaff and medical students after consultation with an attending physician ( control group ) ; ( 2 ) st and ardized verbal instructions given by housestaff and students trained in their use ( verbal group ) ; or ( 3 ) the same instructions given to the verbal group , together with a type-written copy of the information to take home ( verbal + written group ) . Prior to leaving the emergency department and , again , by phone , 1 and 3 days later , parents were question ed concerning the prescribed medication 's name , dose , frequency , and duration of administration ( medication data ) , three signs of improvement , and eight signs indicating the need for medical advice ( worrisome signs ) . The mean percentage of correct responses per parent in each group was computed for each information category . Both at exit interview and at follow-up , parents receiving either form of st and ardized instructions showed significantly greater knowledge of information related to their child 's illness than did controls . Information regarding medication data was more likely to be communicated to parents in all groups than were signs of improvement or worrisome signs . The addition of written instructions to st and ardized verbal instructions did not improve parental recall of discharge information Objectives : This study aims to provide a better underst and ing of the motivations and actions of parents of children with non-urgent injury or illness who attend the emergency department at a tertiary paediatric hospital seeking care . Design : A prospect i ve question naire-based survey of 355 parents aim ed to ascertain information about parent care-giving and care-seeking behaviours prior to presentation at the emergency department with their child . Results : A total of 355 parents were surveyed , representing 8 % of the parents/carers presenting to the emergency department in a 3-month period for non-urgent ( Australasian Triage System 4 and 5 ) care of their child . The factors identified were : parents rated their child ’s condition as moderate to very serious ( 242 ( 68 % ) ) ; two-thirds of parents ( 234 ( 66 % ) ) had sought advice prior to attending the emergency department ; 54 % ( 77 ) of the 137 children who attended with an injury presented promptly to emergency ( ie , within 4 h of injury ) whereas of the 216 presenting with an illness , 41 % ( 88 ) presented within 2–7 days of the onset of the illness . Conclusions : This study displayed the accuracy of “ parental triage , ” that is , parents assess their child ’s health and generally engage in appropriate care-giving and care-seeking behaviours before presenting to a paediatric emergency department . Highlighted are the deficiencies in current primary care services available to families and the perception that not all cases deemed as non-urgent by the emergency department are able to be dealt with in a primary care setting INTRODUCTION The purpose of this study was to examine the effectiveness of fever management education in increasing knowledge , confidence , comfort , and satisfaction of the parent/gr and parent . METHOD A r and omized repeated measures design was used to evaluate the effectiveness of an educational brochure and video . After baseline data were collected on parent/gr and parents of children receiving st and ard care , each site was r and omized into two groups : Group 1 parents were given a video and brochure about fever management as they left the clinic/office ; Group 2 were shown the video and given the brochure before seeing their health care provider . The parent/gr and parents of 216 children , mean age 21.8 months , completed the Fever Management Question naire ( FMQ ) at 48 - 72 hours , 1 , 3 , and 6 months post-education . RESULTS Knowledge scores of parents/gr and parents in both CALM groups were significantly higher than those in the control group at 48 hours and 1-month post-visit . By 6 months , the knowledge level of the parent/gr and parents in CALM2 , those who viewed the video in the office , was significantly different from the other two groups . Satisfaction , comfort , and confidence of all three groups were high at all three points . Parents/gr and parents in both CALM groups were highly satisfied with the education they received . DISCUSSION Educating parent/gr and parents about fever management using written and video material s is effective in increasing knowledge about fever management BACKGROUND A number of previous studies on minor illness have concentrated on nurse-led clinics and the role of nurse practitioners . This study examines the effect of a minor illness education programme which aim ed to increase  parents ' confidence and knowledge in managing childhood illnesses . AIM The primary aim of this study was to evaluate the effectiveness of a home visit and booklet in providing education to parents about minor infant illnesses . DESIGN A r and omized controlled trial was conducted . The intervention involved a home visit to discuss parents ' concerns and provide advice and information , and a booklet advising parents what to do and when to consult about infant illnesses . METHOD A total of 120 parents of 6 week old babies were identified over a 6 month period , using health visitors ' caseloads , and r and omized to an intervention group ( 60 ) , that received a visit and a booklet , or a control group ( 60 ) that received st and ard care .  Groups were compared on entry to the study and at 7 months , in terms of parental knowledge and confidence about childhood illnesses , the intended use of home care activities , intention to consult professionals and actual use of health services . Data were collected by self-completed question naire and case note review . FINDINGS The educational intervention result ed in a reduction in visits to the child health clinic but had little effect on use of other services . Parents in the intervention group showed a general trend towards greater certainty about the home care options they would choose , and a reduction in intention to consult a doctor . However , they also indicated a feeling of reduced confidence and knowledge . CONCLUSION The trial showed no effect on use of services but did demonstrate reduction in parents ' intentions to consult a doctor , which appeared to be because of increased certainty about home care . However , it is of concern that they indicated feeling less confident and knowledgeable . It is not possible to clarify whether this represented anxiety that was constructive , enhancing decision-making or was destructive . Further work into the role of education in parental decision-making , anxiety levels and enhancement of confidence is required BACKGROUND AND OBJECTIVES A substantial proportion of emergency department ( ED ) visits by children are for non-urgent care . The objective of this research is to determine whether a  parent-focused educational intervention can reduce non-urgent ED visits . METHODS A regional hospital system ( which includes a central hospital , four satellite hospitals , and two primary care clinics ) provided monthly data retrospectively from January 2006 to October 2007 on ED visits by children . The same information was provided prospect ively from November 2007 to April 2009 . Starting in November 2007 , a family medicine residency program affiliated with the same hospital network distributed a 6.7 grade reading level booklet on non-urgent care of children to the parents who brought their children to the outpatient clinic . The number of ED visits as a proportion of outpatient clinic visits at the residency program was calculated for each month and compared to historical and geographic trends . RESULTS Long-term changes were observed only among the intervention group . There was a substantial and statistically significant reduction in ED use for non-urgent care of children . There was also a proportional reduction in ED charges for this group . CONCLUSION An educational intervention among parents can substantially reduce non-urgent ED visits for their children Objective : This study was design ed to assess the impact of a brief educational video shown to  parents  during an emergency department visit for minor febrile illnesses . We hypothesized that a video about home management of fever would reduce medically unnecessary return emergency department visits for future febrile episodes . Methods : A convenience sample of 280 caregivers presenting to one urban pediatric emergency department was enrolled in this prospect i ve , r and omized cohort study . All the caregivers presented with a child aged 3 to 36 months with complaint of fever and were independently triaged as nonemergent . A pretest and posttest were administered to assess baseline knowledge and attitudes about fever .  One hundred forty subjects were r and omized to view either an 11-minute video about home management of fever or a control video about child safety . Subjects were tracked prospect ively , and all return visits for fever complaints were independently review ed by 3 pediatric emergency physicians to determine medical necessity . Results : There were no differences between the fever video and the control groups in baseline demographics ( eg , demographically comparable ) . The fever video group had a significant improvement in several measures relating to knowledge and attitudes about childhood fever . There was no statistical difference between the intervention and control groups in subsequent return visits or in the determination of medical necessity . Conclusions : A brief st and ardized video about home management of fever improved caregiver knowledge of fever but did not decrease emergency department use or increase medical necessity for subsequent febrile episodes A booklet was developed in the author 's practice that provided advice for parents on the home management of cough , fever , sore throat , diarrhoea and vomiting in children , and included specific recommendations about when to seek medical help . The effect of distributing this booklet on the frequency of parent-initiated consultations was evaluated in a r and omized , controlled trial . The overall effect of the booklet was a statistically non-significant reduction in consultations for the symptoms that it addressed ( ' booklet symptoms ' ) . However , this finding masked a statistically significant reduction in daytime home visits for booklet symptoms ( especially for cough , fever and sore throat ) and a significant increase in out of hours consultations ( for fever , diarrhoea and vomiting ) . Had all the households in the practice been sent a copy of the booklet then it was estimated that over the following year some 28 % fewer home visits and some 173 % more out of hours consultations would have been undertaken for booklet symptoms than if none of the households had been sent a copy The purpose of this study was to investigate whether the reliability , sensitivity , and specificity of mothers ' judgments about acute illnesses in their children could be improved by using the Acute Illness Observation Scales ( AIOS ) . At the 2-week well child care visit in a primary care center and a private practice , 369 mothers were divided at r and om into an intervention group ( n = 183 ) and a control group ( n = 186 ) . A teaching film and booklet were used to educate mothers in the intervention group about the AIOS ; control group mothers were taught a 3-point global scoring system for evaluating the chance of serious illness . In the 32 months of follow-up , 704 acute illnesses were evaluated in t and em and independently by mothers and pediatricians before the history and physical examination ; 20 of these illnesses were serious . The judgments of the intervention group were more reliable than those of the control group ( weighted kappa = 0.50 vs 0.26 , respectively ) , as was the specificity of their judgments ( 85 % vs 52 % , respectively ; p less than 0.0001 ) . No difference was noted in the sensitivity of intervention group and control group mothers ' judgments ( 80 % vs 90 % , respectively ) . Teaching parents to assess specific clinical information , as represented in the AIOS , has its greatest effect on the reliability and specificity , not the sensitivity , of their judgments . Such teaching could lead to fewer unnecessary office visits during acute illnesses BACKGROUND Parents might not feel the need to make as many visits to an emergency room ( ER ) for a sick child if they had more information about common illnesses and their management . This study measured the effect on future ER use of parent education on common childhood illnesses . METHODS Children who were over 6 months old and had visited the ER at least twice in the preceding year were enrolled in an experimental group ( n = 118 ) or in a control group ( n = 128 ) over consecutive two-month periods . The intervention consisted of a pamphlet and a videotaped presentation that discussed the features and management of common childhood illnesses . RESULTS Over the following year , an average of 0.43 ( SD = 0.9 ) ER visits were made by experimental subjects compared to 0.52 ( SD = 1.31 ) by control subjects ( P = .30 ) . Twenty percent ( SD = .4 ) and 22 % ( SD = .4 ) of subsequent illnesses of experimental and control children respectively result ed in an ER visit . CONCLUSION Our study demonstrated no effect of an educational intervention design ed to decrease ER visits . Limitations of our study , however , suggest that further attempts to educate parents in this setting may still be warranted
OBJECTIVE To identify the effectiveness of information re sources to help parents decide when to seek medical care for an acutely sick child under 5 years of age , including the identification of factors influencing effectiveness , by systematic ally review ing the literature .