Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial

Abstract

D espite recent efforts to decrease the use of antibiotics for acute respiratory infections, their prescription is still too frequent 1,2 and may be contributing to antibiotic resistance. 1 Only 6%-18% of children with acute respiratory infections, 5%-15% of adults with pharyngitis and 38% of adults with acute rhinosinusitis have bacterial infections. 3,4 Studies investigating improvement in clinical decision-making about the use of antibiotics for acute respiratory infections have been inconclusive, and interventions to reduce their use have shown only moderate success. 5 In the shared decision-making model, a health care professional and the patient make a decision together based on the best available evidence and the patient's values and preferences. 6 Shared decision-making is recognized as an effective strategy for reducing the overuse of treatment options not clearly associated with benefits for all patients. 7 In a randomized pilot trial, we showed that an earlier version of the training program in shared decision-making (DECISION+) reduced the proportion of patients who decided to use antibiotics immediately after consulting for acute respiratory infections (control 49%, DECISION+ 33%; absolute difference 16%; p = 0.08), a reduction that was maintained 6 months later. 8 However, because only 46% of enrolled providers in the pilot trial participated in all three 3-hour workshops, we improved the training program before conducting a definitive trial. 9 Following an in-depth evaluation with participants in the pilot trial, 10,11 we modified the training program and renamed it DECISION+2. In the current study, we evaluated its effect on the proportion of patients who decided to use antibiotics for acute respiratory infections after physician consultation. Background: Few interventions have proven effective in reducing the overuse of antibiotics for acute respiratory infections. We evaluated the effect of DECISION+2, a shared decision-making training program, on the percentage of patients who decided to take antibiotics after consultation with a physician or resident.

Shared decision making in primary care: barriers and facilitators of shared decision making in the context of decreasing the use of unnecessary antibiotics for preschool children ages 3-5 with upper respiratory tract infections

“…Seven articles were chosen to further examine facilitators of shared decision making (Brookes-Howell et al, 2014;Butler et al, 2012;Giguere et al, 2012;Hoye et al, 2010;Legare et al, 2013;Legare et al, 2012;Mangione-Smith et al, 2015). Giguere et al (2012) and Butler et al (2012) provided research on the effects of shared decision making education targeted towards PCPs on antibiotic prescribing trends.…”

“…Giguere et al (2012) and Butler et al (2012) provided research on the effects of shared decision making education targeted towards PCPs on antibiotic prescribing trends. Research by Legare et al (2012) and Legare et al (2013) explored the implementation of shared decision making education into primary care settings.…”

“…Legare et al (2012) and Legare et al (2013) explored PCP education and implementation of shared decision making into practice. Although this research also discussed education of PCPs, it was focused more specifically on implementing shared decision making into practice with education and effective communication.…”

“…Although this research also discussed education of PCPs, it was focused more specifically on implementing shared decision making into practice with education and effective communication. Research by Giguere et al (2012) is linked to the research by Legare et al (2012) and Legare et al (2013). While Giguere et al (2012) studied a shared decision making measurement tool in combination with an education program, Legare et al (2012) looked specifically at the implementation of the program into practice.…”

“…Research by Legare et al (2012) demonstrated that interventions effective at increasing patient participation can be utilized in decreasing unnecessary antibiotic use. The inclusion of patients is beneficial, as PCPs may think that shared decision making has occurred, when it was not actually perceived by the patient.…”