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Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections: a pilot clustered randomized controlled trial.
- Source :
- Health Expectations; Mar2011 Supplement, Vol. 14, p96-110, 15p, 2 Diagrams, 4 Charts
- Publication Year :
- 2011
-
Abstract
- Experts estimate that the prevalence of antibiotics use exceeds the prevalence of bacterial acute respiratory infections (ARIs). 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. Two-arm parallel clustered pilot randomized controlled trial. 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. DECISION+ is a multiple-component, continuing professional development program in shared decision making that addresses the use of antibiotics for ARIs. 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. 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. 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. [ABSTRACT FROM AUTHOR]
- Subjects :
- GENERAL practitioners
ANTIBIOTICS
ANALYSIS of variance
ATTITUDE (Psychology)
BEHAVIOR modification
COMPUTER software
CONCEPTUAL structures
CONFIDENCE intervals
STATISTICAL correlation
DRUGS
INTENSIVE care nursing
PATIENTS
PHYSICIANS
PROFESSIONAL employee training
REGRESSION analysis
RESEARCH
RESEARCH funding
RESPIRATORY infections
STATISTICAL sampling
SCALE analysis (Psychology)
STATISTICS
PATIENT participation
DECISION making in clinical medicine
PILOT projects
DATA analysis
RANDOMIZED controlled trials
EDUCATIONAL outcomes
INTER-observer reliability
EVALUATION of human services programs
EDUCATION
Subjects
Details
- Language :
- English
- ISSN :
- 13696513
- Volume :
- 14
- Database :
- Complementary Index
- Journal :
- Health Expectations
- Publication Type :
- Academic Journal
- Accession number :
- 58120906
- Full Text :
- https://doi.org/10.1111/j.1369-7625.2010.00616.x