Shared decision-making tool cuts antibiotic use

By Caroline Price, Senior MedWire Reporter

Patients are much less likely to take antibiotics for an acute respiratory infection if they consult a family doctor who has been trained in shared decision-making, report researchers from Canada.

Their study showed that training family doctors with the shared decision-making program DECISION+2 roughly halved the proportion of patients deciding to use antibiotics immediately after their consultation.

"This occurred with no negative effect on patient outcomes at 2 weeks," note France Légaré (Laval University, Quebec) and colleagues, writing in the Canadian Medical Association Journal.

The DECISION+2 program consisted of a 2-hour online tutorial on the key components of clinical decision-making on antibiotic treatment for acute respiratory infections in primary care, followed by a 2-hour on-site interactive workshop. Both the tutorial and the workshop included videos, exercises, and decision aids to help physicians communicate to their patients the probability of a bacterial acute respiratory infection, and the benefits and harms associated with antibiotic use.

Among 181 patients with suspected acute respiratory infection allocated to see DECISION+2-trained physicians, the proportion who chose to use antibiotics after consulting their doctor fell markedly, from 41.2% before the DECISION+2 intervention period, to 27.2% afterwards.

This compared with an increase from 39.2% before the intervention phase to 52.2% afterwards among 178 similar patients who consulted physicians who did not undergo DECISION+2 training (control group).

The 25.0% absolute difference in antibiotic use between the DECISION+2 and control groups after the intervention translated to a significant 52% reduced relative risk.

The training had no effect on measures of decisional conflict, perception of the quality of the decision among either physicians or patients, decisional regret, repeat consultation, or patient quality of life 2 weeks later, the researchers add.

"Our data suggest that it is possible to train physicians to engage patients actively in decision-making. In the context of acute respiratory infections, this appears to reduce the use of a treatment option (ie, antibiotics) not clearly associated with benefits for all patients," comment Légaré and team.

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