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Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial.
CMAJ. 2012 Sep 18; 184(13):E726-34.CMAJ

Abstract

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.

METHODS

We performed a randomized trial, clustered at the level of family practice teaching unit, with 2 study arms: DECISION+2 and control. The DECISION+2 training program included a 2-hour online tutorial followed by a 2-hour interactive seminar about shared decision-making. The primary outcome was the proportion of patients who decided to use antibiotics immediately after consultation. We also recorded patients' perception that shared decision-making had occurred. Two weeks after the initial consultation, we assessed patients' adherence to the decision, repeat consultation, decisional regret and quality of life.

RESULTS

We compared outcomes among 181 patients who consulted 77 physicians in 5 family practice teaching units in the DECISION+2 group, and 178 patients who consulted 72 physicians in 4 family practice teaching units in the control group. The percentage of patients who decided to use antibiotics after consultation was 52.2% in the control group and 27.2% in the DECISION+2 group (absolute difference 25.0%, adjusted relative risk 0.48, 95% confidence interval 0.34-0.68). DECISION+2 was associated with patients taking a more active role in decision-making (Z = 3.9, p < 0.001). Patient outcomes 2 weeks after consultation were similar in both groups.

INTERPRETATION

The shared decision-making program DECISION+2 enhanced patient participation in decision-making and led to fewer patients deciding to use antibiotics for acute respiratory infections. This reduction did not have a negative effect on patient outcomes 2 weeks after consultation. ClinicalTrials.gov trial register no. NCT01116076.

Authors+Show Affiliations

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

22847969

Citation

Légaré, France, et al. "Training Family Physicians in Shared Decision-making to Reduce the Overuse of Antibiotics in Acute Respiratory Infections: a Cluster Randomized Trial." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 184, no. 13, 2012, pp. E726-34.
Légaré F, Labrecque M, Cauchon M, et al. Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial. CMAJ. 2012;184(13):E726-34.
Légaré, F., Labrecque, M., Cauchon, M., Castel, J., Turcotte, S., & Grimshaw, J. (2012). Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 184(13), E726-34. https://doi.org/10.1503/cmaj.120568
Légaré F, et al. Training Family Physicians in Shared Decision-making to Reduce the Overuse of Antibiotics in Acute Respiratory Infections: a Cluster Randomized Trial. CMAJ. 2012 Sep 18;184(13):E726-34. PubMed PMID: 22847969.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial. AU - Légaré,France, AU - Labrecque,Michel, AU - Cauchon,Michel, AU - Castel,Josette, AU - Turcotte,Stéphane, AU - Grimshaw,Jeremy, Y1 - 2012/07/30/ PY - 2012/8/1/entrez PY - 2012/8/1/pubmed PY - 2012/12/10/medline SP - E726 EP - 34 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 184 IS - 13 N2 - 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. METHODS: We performed a randomized trial, clustered at the level of family practice teaching unit, with 2 study arms: DECISION+2 and control. The DECISION+2 training program included a 2-hour online tutorial followed by a 2-hour interactive seminar about shared decision-making. The primary outcome was the proportion of patients who decided to use antibiotics immediately after consultation. We also recorded patients' perception that shared decision-making had occurred. Two weeks after the initial consultation, we assessed patients' adherence to the decision, repeat consultation, decisional regret and quality of life. RESULTS: We compared outcomes among 181 patients who consulted 77 physicians in 5 family practice teaching units in the DECISION+2 group, and 178 patients who consulted 72 physicians in 4 family practice teaching units in the control group. The percentage of patients who decided to use antibiotics after consultation was 52.2% in the control group and 27.2% in the DECISION+2 group (absolute difference 25.0%, adjusted relative risk 0.48, 95% confidence interval 0.34-0.68). DECISION+2 was associated with patients taking a more active role in decision-making (Z = 3.9, p < 0.001). Patient outcomes 2 weeks after consultation were similar in both groups. INTERPRETATION: The shared decision-making program DECISION+2 enhanced patient participation in decision-making and led to fewer patients deciding to use antibiotics for acute respiratory infections. This reduction did not have a negative effect on patient outcomes 2 weeks after consultation. ClinicalTrials.gov trial register no. NCT01116076. SN - 1488-2329 UR - https://www.unboundmedicine.com/medline/citation/22847969/Training_family_physicians_in_shared_decision_making_to_reduce_the_overuse_of_antibiotics_in_acute_respiratory_infections:_a_cluster_randomized_trial_ L2 - http://www.cmaj.ca/cgi/pmidlookup?view=long&amp;pmid=22847969 DB - PRIME DP - Unbound Medicine ER -