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Randomized Controlled Trial
. 2013 Dec 26:8:144.
doi: 10.1186/1748-5908-8-144.

Impact of DECISION + 2 on patient and physician assessment of shared decision making implementation in the context of antibiotics use for acute respiratory infections

France Légaré  1 , Mireille Guerrier, Catherine Nadeau, Caroline Rhéaume, Stéphane Turcotte, Michel Labrecque
Affiliations
Randomized Controlled Trial

Impact of DECISION + 2 on patient and physician assessment of shared decision making implementation in the context of antibiotics use for acute respiratory infections

France Légaré et al. Implement Sci. .

Abstract

Background: DECISION + 2, a training program for physicians, is designed to implement shared decision making (SDM) in the context of antibiotics use for acute respiratory tract infections (ARTIs). We evaluated the impact of DECISION + 2 on SDM implementation as assessed by patients and physicians, and on physicians' intention to engage in SDM.

Methods: From 2010 to 2011, a multi-center, two-arm, parallel randomized clustered trial appraised the effects of DECISION + 2 on the decision to use antibiotics for patients consulting for ARTIs. We randomized 12 family practice teaching units (FPTUs) to either DECISION + 2 or usual care. After the consultation, both physicians and patients independently completed questionnaires based on the D-Option scale regarding SDM behaviors during the consultation. Patients also answered items assessing the role they assumed during the consultation (active/collaborative/passive). Before and after the intervention, physicians completed a questionnaire based on the Theory of Planned Behavior to measure their intention to engage in SDM. To account for the cluster design, we used generalized estimating equations and generalized linear mixed models to assess the impact of DECISION + 2 on the outcomes of interest.

Results: A total of 270 physicians (66% women) participated in the study. After DECISION + 2, patients' D-Option scores were 80.1 ± 1.1 out of 100 in the intervention group and 74.9 ± 1.1 in the control group (p = 0.001). Physicians' D-Option scores were 79.7 ± 1.8 in the intervention group and 76.3 ± 1.9 in the control group (p = 0.2). However, subgroup analyses showed that teacher physicians D-Option scores were 79.7 ± 1.5 and 73.0 ± 1.4 respectively (p = 0.001). More patients reported assuming an active or collaborative role in the intervention group (67.1%), than in the control group (49.2%) (p = 0.04). There was a significant relation between patients' and physicians' D-Option scores (p < 0.01) and also between patient-reported assumed roles and both D-Option scores (as assessed by patients, p < 0.01; and physicians, p = 0.01). DECISION + 2 had no impact on the intention of physicians to engage in SDM.

Conclusion: DECISION + 2 positively influenced SDM behaviors as assessed by patients and teacher physicians. Physicians' intention to engage in SDM was not affected by DECISION + 2.

Trial registration: ClinicalTrials.gov trials register no. NCT01116076.

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Figures

Figure 1
Figure 1
The questionnaire flowchart showing the outcomes assessed at each point of time.
Figure 2
Figure 2
The flow study of participants showing the number of eligible health professionals in each group. *We included only the participating physicians who had completed their entry questionnaire before DECISION+2 was delivered. Thus we included 151 physicians in the intervention group and 99 in the control group.
See this image and copyright information in PMC

References

    1. Patrick DM, Hutchinson J. Antibiotic use and population ecology: how you can reduce your “resistance footprint”. Can Med Assoc J. 2009;8:416–421. doi: 10.1503/cmaj.080626. - DOI - PMC - PubMed
    1. Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev. 2005;8 CD003539. - PMC - PubMed
    1. Butler CC, Hood K, Verheij T, Little P, Melbye H, Nuttall J, Kelly MJ, Molstad S, Godycki-Cwirko M, Almirall J. et al.Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries. BMJ. 2009;8:b2242. doi: 10.1136/bmj.b2242. - DOI - PMC - PubMed
    1. Legare F, Labrecque M, Godin G, LeBlanc A, Laurier C, Grimshaw J, Castel J, Tremblay I, Fremont P, Cauchon M. et al.Training family physicians and residents in family medicine in shared decision making to improve clinical decisions regarding the use of antibiotics for acute respiratory infections: protocol for a clustered randomized controlled trial. BMC Fam Pract. 2011;8:3. doi: 10.1186/1471-2296-12-3. - DOI - PMC - PubMed
    1. Legare F, Labrecque M, Cauchon M, Castel J, Turcotte S, Grimshaw J. Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial. CMAJ. 2012;8(13):E726–E734. doi: 10.1503/cmaj.120568. - DOI - PMC - PubMed

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