Imperial College London
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DrOlgaKostopoulou

Faculty of Medicine, Department of Surgery & Cancer

Reader in Medical Decision Making
 
 
 
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Contact

 

o.kostopoulou Website

 
 
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Location

 

5.07Medical SchoolSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Nurek:2023:10.3399/bjgp.2020.0802,
author = {Nurek, M and Hay, AD and Kostopoulou, O},
doi = {10.3399/bjgp.2020.0802},
journal = {British Journal of General Practice},
pages = {e176--e185},
title = {Online experiment comparing GPs’ antibiotic prescribing decisions to a clinical prediction rule},
url = {http://dx.doi.org/10.3399/bjgp.2020.0802},
volume = {73},
year = {2023}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background: The“STARWAVe” clinical prediction rule (CPR) uses seven factors toguide risk assessment and antibiotic prescribing in children with cough (Short illnessduration, Temperature, Age, Recession, Wheeze, Asthma, Vomiting).Aim: To assess the influence of STARWAVe factors on General Practitioners’ (GPs)unaided risk assessments and prescribing decisions. We also explored two methodsof obtaining risk assessments and tested the impact of parental concern.Design and setting: Experiment comprising clinical vignettes administered to 188 UKGPs online.Method: GPs were randomly assigned to view 32 (of 64) vignettes depicting childrenwith cough. Vignettes varied the STARWAVe factors systematically. Per vignette, GPsassessed risk of deterioration in one of two ways (sliding scale vs. risk categoryselection) and indicated whether they would prescribe antibiotics. Finally, they saw anadditional vignette, suggesting that the parent was concerned. Using mixed-effectsregressions, we measured the influence of STARWAVe factors, risk elicitationmethod, and parental concern on GPs' assessments and decisions.Results: Six STARWAVe risk factors correctly increased GPs’ risk assessments(bssliding-scale0.66, ORscategory-selection1.61, ps0.001) while one incorrectly reducedthem (short duration: bsliding-scale=-0.31, ORcategory-selection=0.75, ps0.039). Conversely,one STARWAVe factor increased prescribing odds (fever: OR=5.22, p<0.001) whilethe rest either reduced them (short duration, age, recession: ORs0.70, ps<0.001) orhad no significant impact (wheeze, asthma, vomiting: ps0.065). Parental concernincreased risk assessments (bsliding-scale=1.29, ORcategory-selection=2.82, ps0.003) butnot prescribing (p=0.378).Conclusion: GPs use some, but not all, STARWAVe factors when making unaidedrisk assessments and prescribing decisions. Such discrepancies must be consideredwhen introducing CPRs to clinical practice.
AU  - Nurek,M
AU  - Hay,AD
AU  - Kostopoulou,O
DO  - 10.3399/bjgp.2020.0802
EP  - 185
PY  - 2023///
SN  - 0960-1643
SP  - 176
TI  - Online experiment comparing GPs’ antibiotic prescribing decisions to a clinical prediction rule
T2  - British Journal of General Practice
UR  - http://dx.doi.org/10.3399/bjgp.2020.0802
UR  - https://bjgp.org/content/early/2022/11/30/BJGP.2020.0802
UR  - http://hdl.handle.net/10044/1/101323
VL  - 73
ER  -
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