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Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections: a pilot clustered randomized controlled trial.
Health Expect. 2011 Mar; 14 Suppl 1:96-110.HE

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.

Authors+Show Affiliations

Research Centre of the Centre Hospitalier Universitaire de Québec, Québec, QC, Canada. france.legare@mfa.ulaval.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20629764

Citation

Légaré, France, et al. "Training Family Physicians in Shared Decision Making for the Use of Antibiotics for Acute Respiratory Infections: a Pilot Clustered Randomized Controlled Trial." Health Expectations : an International Journal of Public Participation in Health Care and Health Policy, vol. 14 Suppl 1, 2011, pp. 96-110.
Légaré F, Labrecque M, LeBlanc A, et al. Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections: a pilot clustered randomized controlled trial. Health Expect. 2011;14 Suppl 1:96-110.
Légaré, F., Labrecque, M., LeBlanc, A., Njoya, M., Laurier, C., Côté, L., Godin, G., Thivierge, R. L., O'Connor, A., & St-Jacques, S. (2011). Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections: a pilot clustered randomized controlled trial. Health Expectations : an International Journal of Public Participation in Health Care and Health Policy, 14 Suppl 1, 96-110. https://doi.org/10.1111/j.1369-7625.2010.00616.x
Légaré F, et al. Training Family Physicians in Shared Decision Making for the Use of Antibiotics for Acute Respiratory Infections: a Pilot Clustered Randomized Controlled Trial. Health Expect. 2011;14 Suppl 1:96-110. PubMed PMID: 20629764.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections: a pilot clustered randomized controlled trial. AU - Légaré,France, AU - Labrecque,Michel, AU - LeBlanc,Annie, AU - Njoya,Merlin, AU - Laurier,Claudine, AU - Côté,Luc, AU - Godin,Gaston, AU - Thivierge,Robert L, AU - O'Connor,Annette, AU - St-Jacques,Sylvie, PY - 2010/7/16/entrez PY - 2010/7/16/pubmed PY - 2011/5/21/medline SP - 96 EP - 110 JF - Health expectations : an international journal of public participation in health care and health policy JO - Health Expect VL - 14 Suppl 1 N2 - 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. SN - 1369-7625 UR - https://www.unboundmedicine.com/medline/citation/20629764/Training_family_physicians_in_shared_decision_making_for_the_use_of_antibiotics_for_acute_respiratory_infections:_a_pilot_clustered_randomized_controlled_trial_ L2 - https://doi.org/10.1111/j.1369-7625.2010.00616.x DB - PRIME DP - Unbound Medicine ER -