TY - JOUR
T1 - Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections
T2 - 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 - 2011/3
Y1 - 2011/3
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.
AB - 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.
KW - Acute respiratory infections
KW - Continuing medical education
KW - Continuing professional development
KW - Implementation
KW - Randomized control trial
KW - Shared decision making
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U2 - 10.1111/j.1369-7625.2010.00616.x
DO - 10.1111/j.1369-7625.2010.00616.x
M3 - Article
C2 - 20629764
AN - SCOPUS:79951604780
SN - 1369-6513
VL - 14
SP - 96
EP - 110
JO - Health Expectations
JF - Health Expectations
IS - SUPPL. 1
ER -