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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

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 ant...

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Detalles Bibliográficos
Autores principales: Légaré, France, Labrecque, Michel, LeBlanc, Annie, Njoya, Merlin, Laurier, Claudine, Côté, Luc, Godin, Gaston, Thivierge, Robert L., O’Connor, Annette, St‐Jacques, Sylvie
Formato: Texto
Lenguaje:English
Publicado: Blackwell Publishing Ltd 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073122/
https://www.ncbi.nlm.nih.gov/pubmed/20629764
http://dx.doi.org/10.1111/j.1369-7625.2010.00616.x
Descripción
Sumario: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.