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Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis
Ruben Burvenich1, David Ag Bos1, Lien Lowie2
1Leuven Unit for Health Technology Assessment Research (LUHTAR), Department of Public Health and Primary Care, KU Leuven; Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Insights
Safety-netting advice (SNA) for acutely ill children can reduce antibiotic prescribing and consumption, especially when using paper and oral methods. Various SNA formats, including video and online, may improve parental knowledge and satisfaction.
Area of Science:
- Pediatric Health
- Infectious Disease Management
- Health Communication
Background:
- Safety-netting advice (SNA) is a strategy to manage acutely ill children.
- Effective SNA can influence parental understanding and adherence to medical advice.
Purpose of the Study:
- To evaluate the comparative effectiveness of different SNA methods.
- To assess the impact of SNA on antibiotic prescribing and consumption in pediatric care.
Main Methods:
- Systematic review and network meta-analysis of multiple study designs.
- Searched major databases including MEDLINE, Embase, and Cochrane.
- Assessed risk of bias and certainty of evidence using established tools.
Main Results:
- Paper SNA, particularly with oral components, significantly reduced antibiotic prescribing and consumption.
- Video, oral, and web-based SNA interventions improved parental knowledge.
- Video SNA and web-based modules enhanced parental satisfaction.
Conclusions:
- Paper SNA combined with oral advice is effective in reducing antibiotic use and return visits.
- Digital and interactive SNA formats show promise for improving parental knowledge and satisfaction.
Background:
Safety-netting advice (SNA) can help in the management of acutely ill children.
Aim:
To assess the effectiveness of different SNA methods on antibiotic prescription and consumption in acutely ill children.
Design And Setting:
Systematic review and network meta-analysis of randomised controlled trials, cluster randomised trials, non-randomised studies of interventions, and controlled before-after studies in ambulatory care in high-income countries.
Method:
MEDLINE, Embase, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials were searched (22 January 2024). Risk of bias (RoB) was assessed with Cochrane's RoB 2 tool, the Revised Cochrane Tool for Cluster-Randomised Trials, and the Risk Of Bias In Non-randomised Studies - of Interventions tool. Certainty of evidence was assessed using the Confidence in Network Meta-Analysis approach. Sensitivity analyses and network meta-regression were performed.
Results:
In total, 30 studies (20 interventions) were included. Compared with usual care, paper SNA may reduce: antibiotic prescribing (odds ratio [OR] 0.66, 95% confidence interval [CI] = 0.53 to 0.82, I 2 = 92%, very low certainty, three studies, 35 988 participants), especially when combined with oral SNA (OR 0.40, 95% CI = 0.08 to 2.00, P-score = 0.86); antibiotic consumption (OR 0.39, 95% CI = 0.27 to 0.58, low RoB, one study, 509 participants); and return visits (OR 0.74, 95% CI = 0.63 to 0.87). Compared with usual care, video SNA, read-only websites, oral SNA, and web-based SNA (in descending order of effectiveness) may increase parental knowledge (ORs 2.33-4.52), while paper SNA may not (ORs 1.18-1.62). Similarly, compared with usual care, video SNA and web-based modules may improve parental satisfaction (ORs 1.94-4.08), while paper SNA may not (OR 1.85, 95% CI = 0.48 to 7.08).
Conclusion:
Paper SNA (with oral SNA) may reduce antibiotic use and return visits. Video, oral, and online SNA may improve parental knowledge, whereas video SNA and web-based modules may increase parental satisfaction.
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