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Engaging Patients in Decision Helps Reduce Antibiotic Use


July 30, 2012 — Training physicians to engage patients in decision-making can reduce the prescription of unnecessary antibiotics for acute respiratory infections, according to a randomized trial of 359 patients published in the Canadian Medical Association Journal.
In the cluster randomized trial, the use of antibiotics for acute respiratory infection was reduced by 25% among patients of Canadian physicians from 5 family practices who were trained in physician–patient shared decision-making compared with use among patients of physicians who provided "usual care" (27.2% vs 52.2%; adjusted relative risk, 0.48; 95% confidence interval, 0.34 - 0.68).
The reduction in antibiotic use had no significant effect on patient outcomes from respiratory infection 2 weeks after patients consulted with their physicians about symptoms of acute respiratory infection, according to lead author France Légaré, MD, PhD, from the Research Centre of the Centre Hospitalier Universitaire de Québec and the Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada, and colleagues.
"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 (i.e., antibiotics) not clearly associated with benefits for all patients," the authors write.
In the multicenter, parallel cluster randomized trial, the researchers compared use of antibiotics for acute respiratory infection among patients of 77 physicians who participated in the physician–patient shared decision-making training program with prescriptions for antibiotics among 72 physicians who provided usual care.
As well as reducing use of antibiotics for acute respiratory infections, patients of physicians who took the training program took a more active role in decision-making about their treatment compared with patients of physicians in the control group (P < .001). Active patient decision-making was assessed by a questionnaire after the physician–patient consultation and the Control Preference Scale, which assessed patient perceptions that shared decision-making had occurred.
The shared decision-making training program, known as DECISION+2, consisted of a 2-hour online tutorial followed by a 2-hour interactive seminar on shared physician–patient decision-making. The program included information about the scientific evidence for use of antibiotics in acute respiratory infection as well as training in communication with patients about the risks and benefits of antibiotic use.
In the training program, physicians were also educated about ways to promote active patient participation in the decision of whether or not to use antibiotics. These techniques included asking patients about their preferences and values and verifying patient comfort with the final decision about use of antibiotics.
The authors noted that training programs in shared patient–clinician decision-making might be useful in other settings such as emergency departments or to train nurses to help patients make informed decisions based on their values before visiting a physician or emergency department.
The study was funded by a grant from the Conseil du médicament du Québec/Fonds de la recherche en santé du Québec. The authors have disclosed no relevant financial relationships.

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