Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections: A pilot clustered randomized controlled trial

France Légaré, Michel Labrecque, Annie LeBlanc, Merlin Njoya, Claudine Laurier, Luc Côté, Gaston Godin, Robert L. Thivierge, Annette O'Connor, Sylvie St-Jacques

Research output: Contribution to journalArticle

50 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)96-110
Number of pages15
JournalHealth Expectations
Volume14
Issue numberSUPPL. 1
DOIs
StatePublished - Mar 2011
Externally publishedYes

Fingerprint

Family Physicians
Respiratory Tract Infections
Decision Making
Randomized Controlled Trials
Anti-Bacterial Agents
Health Status
Emotions
Control Groups
Referral and Consultation
Medicine
Outcome Assessment (Health Care)

Keywords

  • Acute respiratory infections
  • Continuing medical education
  • Continuing professional development
  • Implementation
  • Randomized control trial
  • Shared decision making

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections : A pilot clustered randomized controlled trial. / Légaré, France; Labrecque, Michel; LeBlanc, Annie; Njoya, Merlin; Laurier, Claudine; Côté, Luc; Godin, Gaston; Thivierge, Robert L.; O'Connor, Annette; St-Jacques, Sylvie.

In: Health Expectations, Vol. 14, No. SUPPL. 1, 03.2011, p. 96-110.

Research output: Contribution to journalArticle

Légaré, F, Labrecque, M, LeBlanc, A, Njoya, M, Laurier, C, Côté, L, Godin, G, Thivierge, RL, 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, vol. 14, no. SUPPL. 1, pp. 96-110. https://doi.org/10.1111/j.1369-7625.2010.00616.x
Légaré, France ; Labrecque, Michel ; LeBlanc, Annie ; Njoya, Merlin ; Laurier, Claudine ; Côté, Luc ; Godin, Gaston ; Thivierge, Robert L. ; O'Connor, Annette ; St-Jacques, Sylvie. / Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections : A pilot clustered randomized controlled trial. In: Health Expectations. 2011 ; Vol. 14, No. SUPPL. 1. pp. 96-110.
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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.",
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AU - Laurier, Claudine

AU - Côté, Luc

AU - Godin, Gaston

AU - Thivierge, Robert L.

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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.

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