Format

Send to

Choose Destination
See comment in PubMed Commons below
Health Expect. 2011 Mar;14 Suppl 1:96-110. doi: 10.1111/j.1369-7625.2010.00616.x.

Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections: a pilot clustered randomized controlled trial.

Author information

1
Research Centre of the Centre Hospitalier Universitaire de Québec, Québec, QC, Canada. france.legare@mfa.ulaval.ca

Abstract

BACKGROUND:

Experts estimate that the prevalence of antibiotics use exceeds the prevalence of bacterial acute respiratory infections (ARIs).

OBJECTIVE:

To develop, adapt and validate DECISION+ and estimate its impact on the decision of family physicians (FPs) and their patients on whether to use antibiotics for ARIs.

DESIGN:

Two-arm parallel clustered pilot randomized controlled trial.

SETTING AND PARTICIPANTS:

Four family medicine groups were randomized to immediate DECISION+ participation (the experimental group) or delayed DECISION+ participation (the control group). Thirty-three FPs and 459 patients participated.

INTERVENTION:

DECISION+ is a multiple-component, continuing professional development program in shared decision making that addresses the use of antibiotics for ARIs.

MAIN OUTCOME MEASURES:

Throughout the pilot trial, DECISION+ was adapted in response to participant feedback. After the consultation, patients and FPs independently self-reported the decision (immediate use, delayed use, or no use of antibiotics) and its quality. Agreement between their decisional conflict was assessed. Two weeks later, patients assessed their decisional regret and health status.

RESULTS:

Compared to the control group, the experimental group reduced its immediate use of antibiotics (49 vs. 33% absolute difference = 16%; P = 0.08). Decisional conflict agreement was stronger in the experimental group (absolute difference of Pearson's r = 0.26; P = 0.06). Decisional regret and perceptions of the quality of the decision and of health status in the two groups were similar.

DISCUSSION AND CONCLUSIONS:

DECISION+ was developed successfully and appears to reduce the use of antibiotics for ARIs without affecting patients' outcomes. A larger trial is needed to confirm this observation.

PMID:
20629764
PMCID:
PMC3073122
DOI:
10.1111/j.1369-7625.2010.00616.x
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Wiley Icon for PubMed Central
    Loading ...
    Support Center