{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T13:06:25Z","timestamp":1769605585219,"version":"3.49.0"},"reference-count":26,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2021,3,27]],"date-time":"2021-03-27T00:00:00Z","timestamp":1616803200000},"content-version":"unspecified","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["16\/31\/98"],"award-info":[{"award-number":["16\/31\/98"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,1,13]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Respiratory tract infections (RTIs) in children are common and present major resource implications for primary care. Unnecessary use of antibiotics is associated with the development and proliferation of antimicrobial resistance. In 2016, the National Institute for Health Research (NIHR)-funded \u2018TARGET\u2019 programme developed a prognostic algorithm to identify children with acute cough and RTI at very low risk of 30-day hospitalisation and unlikely to need antibiotics. The intervention includes: (1) explicit elicitation of parental concerns, (2) the results of the prognostic algorithm accompanied by prescribing guidance and (3) provision of a printout for carers including safety netting advice. The CHIldren\u2019s COugh feasibility study suggested differential recruitment of healthier patients in control practices. This phase III \u2018efficiently designed\u2019 trial uses routinely collected data at the practice level, thus avoiding individual patient consent. The aim is to assess whether embedding a multifaceted intervention into general practitioner (GP) practice Information Technology (IT) systems will result in reductions of antibiotic prescribing without impacting on hospital attendance for RTI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>The coprimary outcomes are (1) practice rate of dispensed amoxicillin and macrolide antibiotics, (2) hospital admission rate for RTI using routinely collected data by Clinical Commissioning Groups (CCGs). Data will be collected for children aged 0\u20139 years registered at 310 practices (155 intervention, 155 usual care) over a 12-month period. Recruitment and randomisation of practices (using the Egton Medical Information Systems web data management system) is conducted via each CCG stratified for children registered and baseline dispensing rates of each practice. Secondary outcomes will explore intervention effect modifiers. Qualitative interviews will explore intervention usage. The economic evaluation will be limited to a between-arm comparison in a cost\u2013consequence analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>Research ethics approval was given by London-Camden and Kings Cross Research Ethics Committee (ref:18\/LO\/0345). This manuscript refers to protocol V.4.0. Results will be disseminated through peer-reviewed journals and international conferences.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"ISRCTN11405239\">ISRCTN11405239<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-041769","type":"journal-article","created":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T11:20:29Z","timestamp":1617016829000},"page":"e041769","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Protocol for an \u2018efficient design\u2019 cluster randomised controlled trial to evaluate a complex intervention to improve antibiotic prescribing for CHIldren presenting to primary care with acute COugh and respiratory tract infection: the CHICO study"],"prefix":"10.1136","volume":"11","author":[{"given":"Penny","family":"Seume","sequence":"first","affiliation":[{"name":"Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Bevan","sequence":"additional","affiliation":[{"name":"Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"Young","sequence":"additional","affiliation":[{"name":"Bristol Trials Centre (Bristol Randomised Trial Collaboration), Bristol Medical School, University of Bristol, University of Bristol, Bristol, Avon, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2366-008X","authenticated-orcid":false,"given":"Jenny","family":"Ingram","sequence":"additional","affiliation":[{"name":"Centre for Academic Child Health, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5555-433X","authenticated-orcid":false,"given":"Clare","family":"Clement","sequence":"additional","affiliation":[{"name":"Bristol Trials Centre (Bristol Randomised Trial Collaboration), Bristol Medical School, University of Bristol, University of Bristol, Bristol, Avon, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christie","family":"Cabral","sequence":"additional","affiliation":[{"name":"Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia Jane","family":"Lucas","sequence":"additional","affiliation":[{"name":"School for Policy Studies, Unversity of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Beech","sequence":"additional","affiliation":[{"name":"Regional Antimicrobial Stewardship Lead South West Region, NHS Improvement, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jodi","family":"Taylor","sequence":"additional","affiliation":[{"name":"Bristol Trials Centre (Bristol Randomised Trial Collaboration), Bristol Medical School, University of Bristol, University of Bristol, Bristol, Avon, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy","family":"Horwood","sequence":"additional","affiliation":[{"name":"Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, 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