Tags

Type your tag names separated by a space and hit enter

Training family physicians and residents in family medicine in shared decision making to improve clinical decisions regarding the use of antibiotics for acute respiratory infections: protocol for a clustered randomized controlled trial.
BMC Fam Pract. 2011 Jan 26; 12:3.BF

Abstract

BACKGROUND

To explore ways to reduce the overuse of antibiotics for acute respiratory infections (ARIs), we conducted a pilot clustered randomized controlled trial (RCT) to evaluate DECISION+, a training program in shared decision making (SDM) for family physicians (FPs). This pilot project demonstrated the feasibility of conducting a large clustered RCT and showed that DECISION+ reduced the proportion of patients who decided to use antibiotics immediately after consulting their physician. Consequently, the objective of this study is to evaluate, in patients consulting for ARIs, if exposure of physicians to a modified version of DECISION+, DECISION+2, would reduce the proportion of patients who decide to use antibiotics immediately after consulting their physician.

METHODS/DESIGN

The study is a multi-center, two-arm, parallel clustered RCT. The 12 family practice teaching units (FPTUs) in the network of the Department of Family Medicine and Emergency Medicine of Université Laval will be randomized to a DECISION+2 intervention group (experimental group) or to a no-intervention control group. These FPTUs will recruit patients consulting family physicians and residents in family medicine enrolled in the study. There will be two data collection periods: pre-intervention (baseline) including 175 patients with ARIs in each study arm, and post-intervention including 175 patients with ARIs in each study arm (total n = 700). The primary outcome will be the proportion of patients reporting a decision to use antibiotics immediately after consulting their physician. Secondary outcome measures include: 1) physicians and patients' decisional conflict; 2) the agreement between the parties' decisional conflict scores; and 3) perception of patients and physicians that SDM occurred. Also in patients, at 2 weeks follow-up, adherence to the decision, consultation for the same reason, decisional regret, and quality of life will be assessed. Finally, in both patients and physicians, intention to engage in SDM in future clinical encounters will be assessed. Intention-to-treat analyses will be applied and account for the nested design of the trial will be taken into consideration.

DISCUSSION

DECISION+2 has the potential to reduce antibiotics use for ARIs by priming physicians and patients to share decisional process and empowering patients to make informed, value-based decisions.

Authors+Show Affiliations

Research Center of Centre Hospitalier Universitaire de Québec, Hospital St-François D'Assise, Knowledge Transfer and Health Technology Assessment Research Group, 10 Espinay, Québec, QC, G1L 3L5, 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 availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21269509

Citation

Légaré, France, et al. "Training Family Physicians and Residents in Family Medicine in Shared Decision Making to Improve Clinical Decisions Regarding the Use of Antibiotics for Acute Respiratory Infections: Protocol for a Clustered Randomized Controlled Trial." BMC Family Practice, vol. 12, 2011, p. 3.
Légaré F, Labrecque M, Godin G, et al. Training family physicians and residents in family medicine in shared decision making to improve clinical decisions regarding the use of antibiotics for acute respiratory infections: protocol for a clustered randomized controlled trial. BMC Fam Pract. 2011;12:3.
Légaré, F., Labrecque, M., Godin, G., LeBlanc, A., Laurier, C., Grimshaw, J., Castel, J., Tremblay, I., Frémont, P., Cauchon, M., Lemieux, K., & Rhéaume, C. (2011). Training family physicians and residents in family medicine in shared decision making to improve clinical decisions regarding the use of antibiotics for acute respiratory infections: protocol for a clustered randomized controlled trial. BMC Family Practice, 12, 3. https://doi.org/10.1186/1471-2296-12-3
Légaré F, et al. Training Family Physicians and Residents in Family Medicine in Shared Decision Making to Improve Clinical Decisions Regarding the Use of Antibiotics for Acute Respiratory Infections: Protocol for a Clustered Randomized Controlled Trial. BMC Fam Pract. 2011 Jan 26;12:3. PubMed PMID: 21269509.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Training family physicians and residents in family medicine in shared decision making to improve clinical decisions regarding the use of antibiotics for acute respiratory infections: protocol for a clustered randomized controlled trial. AU - Légaré,France, AU - Labrecque,Michel, AU - Godin,Gaston, AU - LeBlanc,Annie, AU - Laurier,Claudine, AU - Grimshaw,Jeremy, AU - Castel,Josette, AU - Tremblay,Isabelle, AU - Frémont,Pierre, AU - Cauchon,Michel, AU - Lemieux,Kathleen, AU - Rhéaume,Caroline, Y1 - 2011/01/26/ PY - 2010/12/07/received PY - 2011/01/26/accepted PY - 2011/1/29/entrez PY - 2011/1/29/pubmed PY - 2011/5/19/medline SP - 3 EP - 3 JF - BMC family practice JO - BMC Fam Pract VL - 12 N2 - BACKGROUND: To explore ways to reduce the overuse of antibiotics for acute respiratory infections (ARIs), we conducted a pilot clustered randomized controlled trial (RCT) to evaluate DECISION+, a training program in shared decision making (SDM) for family physicians (FPs). This pilot project demonstrated the feasibility of conducting a large clustered RCT and showed that DECISION+ reduced the proportion of patients who decided to use antibiotics immediately after consulting their physician. Consequently, the objective of this study is to evaluate, in patients consulting for ARIs, if exposure of physicians to a modified version of DECISION+, DECISION+2, would reduce the proportion of patients who decide to use antibiotics immediately after consulting their physician. METHODS/DESIGN: The study is a multi-center, two-arm, parallel clustered RCT. The 12 family practice teaching units (FPTUs) in the network of the Department of Family Medicine and Emergency Medicine of Université Laval will be randomized to a DECISION+2 intervention group (experimental group) or to a no-intervention control group. These FPTUs will recruit patients consulting family physicians and residents in family medicine enrolled in the study. There will be two data collection periods: pre-intervention (baseline) including 175 patients with ARIs in each study arm, and post-intervention including 175 patients with ARIs in each study arm (total n = 700). The primary outcome will be the proportion of patients reporting a decision to use antibiotics immediately after consulting their physician. Secondary outcome measures include: 1) physicians and patients' decisional conflict; 2) the agreement between the parties' decisional conflict scores; and 3) perception of patients and physicians that SDM occurred. Also in patients, at 2 weeks follow-up, adherence to the decision, consultation for the same reason, decisional regret, and quality of life will be assessed. Finally, in both patients and physicians, intention to engage in SDM in future clinical encounters will be assessed. Intention-to-treat analyses will be applied and account for the nested design of the trial will be taken into consideration. DISCUSSION: DECISION+2 has the potential to reduce antibiotics use for ARIs by priming physicians and patients to share decisional process and empowering patients to make informed, value-based decisions. SN - 1471-2296 UR - https://www.unboundmedicine.com/medline/citation/21269509/Training_family_physicians_and_residents_in_family_medicine_in_shared_decision_making_to_improve_clinical_decisions_regarding_the_use_of_antibiotics_for_acute_respiratory_infections:_protocol_for_a_clustered_randomized_controlled_trial_ L2 - https://bmcfampract.biomedcentral.com/articles/10.1186/1471-2296-12-3 DB - PRIME DP - Unbound Medicine ER -