The perspectives of parents, general practitioners, and community pharmacists about treating an ill child in primary care: a comparative study

Evaluation of the "3 Good Questions" program for shared decision-making in pediatric medicine: a feasibility study

The "3 Good Questions" program was developed to increase shared decision making. The current pilot-study determined the feasibility of these questions to increase shared decision-making in Dutch pediatric medicine. Pre-/postintervention surveys were used to include children (10-18 years) at pediatric outpatient clinics of four hospitals in the Netherlands. After their appointment, two different groups of children completed the questionnaires. Group 1 filled in the survey before the intervention; group 2 completed the survey after active implementation of the "3 Good Questions" program. The primary outcome was to determine the feasibility (reach, applicability). Secondary outcomes were related to patient involvement in healthcare and treatment decisions and decision-making process between child and healthcare professional. In total, 168 and 114 children in groups 1 and 2 (61 vs 63% female, P = 0.68; age 13.3 ± 2.4 vs 13.8 ± 2.4 years, P = 0.72), respectively, completed the questionnaire. In group 2, 44% of children were aware of the "3 Good Questions", of whom 18% posed ≥ 1 of the "3 Good Questions" during their appointment (feasibility). The "3 Good Questions" program led to more shared decision-making (SDM-Q-9: P = < 0.001;95%CI: - 2.43 to - 1.17). The majority of children who have read or heard of the "3 Good Questions" would recommend this program to other children.Conclusion: Implementation of the "3 Good Questions" program seemed feasible, although it is necessary to further explore the implementation of this program at national level as a simple way for children and healthcare professionals to share decisions in practice. What is known • Children have the right to be included in decision-making, and inclusion can improve patient satisfaction and quality of care, and reduce costs. • The "3 Good Questions" program was successfully implemented in adult healthcare to increase shared decision making, and therefore these "3 Good Questions" have been adapted to a child version. What is new • In this pilot study, we found that the implementation of the "3 Good Questions" program to increase shared decision-making in pediatric medicine seemed feasible. Although it is necessary to further explore the implementation of the "3 Good Questions" program at national level as a simple way for children and healthcare professionals to share decisions in practice.

Perspectives of Parents and Health Care Providers about (Non)Medical Treatment in Infants with Reflux

Background: Reflux occurs in 50% of healthy infants at some point. This is most often a physiological condition and does not require drug treatment. Various studies have shown that the use of drugs affecting gastric acidity (DAGAs) in infants is increasing. This entails disadvantages such as unnecessary exposure of infants to medication and their side effects and a higher cost to society. Objective: To get an image of the current practice in Flanders regarding diagnosis and treatment of gastro-oesophageal reflux disease (GORD) in infants and the associated use of DAGAs. To this end, we determined both parents’ and health care providers’ experiences and perceptions about these treatments. Method: An observational cross-sectional study was conducted in April and May 2019. We developed a questionnaire for parents and three different questionnaires for health care providers (HCPs), including midwives, general practitioners, paediatricians and community pharmacists (CPs). The questionnaire for parents was only available through an online platform. HCPs were questioned face-to-face and through an online platform. Results: This study made clear that the counselling of children with GORD is multidisciplinary as the median number of counselling HCPs is 3 (interquartile range (IQR) = 2–4). 63% of the included 251 parents also seek support through online forums and groups. 60% of parents report that no physical tests were performed before DAGAs were prescribed and 39% of parents additionally state they perceived no effect of the prescribed DAGAs. Although parents reported to understand HCPs well (average score 7.4/10), satisfaction with care and information provision was scored lower (between 4.8 and 6.1/10). On the other hand, 234 HCPs answered the questionnaire, of which 89 midwives, 78 community pharmacists and 67 physicians. Only 45 HCPs indicate that guidelines to diagnose or treat GORD are clear. Physicians confirm they perform very little physical testing before starting DAGAs. Provided nonmedical measures to patients are largely in line with the European guidelines, however perceived effectiveness is moderate. Conclusion: Parents are in need for more information about tests, nutrition and (non)medical measures. HCPs on the other hand are in need for clear guidelines on diagnosing and treating GORD.