July 31, 2012

Shared Decision-Making Reduces Antibiotic Use

(Ivanhoe Newswire) — A new training tool that helps doctors involve patients in decision-making has been shown to help reduce the use of antibiotics for acute respiratory infections.

Antibiotics are often prescribed for respiratory infections, though many are not bacterial infections and will not respond to antibiotic use. It could be dangerous because antibiotic overuse could lead to antibiotic resistance in addition to being a health concern.

A cluster randomized trial was conducted to determine the effect of a shared decision-making training program called DECISION+2 on the use of antibiotics. Shared decision-making is a process where a health care professional and patient make a decision together based on evidence and patient preferences; it has been shown to be effective when the benefits of treatment are not clear for all patients.

The study was divided into two groups, one group of 181 patients who consulted 77 physicians in 5 family practice teaching units using DECISION+2 and a control group of 178 patients who consulted 72 physicians in 4 family practice teaching units. DECISION+2 included an online tutorial followed by an interactive workshop.

"After the intervention, patients in the DECISION+2 group were significantly less likely than patients in the control group to report a decision to use antibiotics immediately after consultation," Dr. France Légaré, Research Centre of Centre Hospitalier Universitaire de Québec and Department of Family Medicine and Emergency Medicine, Universitaire Laval, Québec, was quoted as saying. "The reduction in decisions to use antibiotics was observed in all intervention teaching units, while an increase was seen in 3 of 4 teaching units in the control group."

These study results are similar to those from an earlier pilot study that analyzed the feasibility of this larger trial.

"These studies indicate that a combination of live and media education are generally effective in changing physician performance in the context of antibiotic use for acute respiratory infections," the authors were quoted as saying. "These findings are important given the debate and widespread skepticism about the effect of medical education on the performance of physicians in the practice setting."

Source: Canadian Medical Association Journal, July 2012