Doctor-Patient Discussion Can Reduce Antibiotic Use

Shared decision making may fight antibiotic resistance

(RxWiki News) Many people are prescribed antibiotics for acute respiratory infections, such as the common cold. But are the antibiotics prescribed doing more harm than good? 

A new study says that antibiotic overuse is troubling, and enhanced patient participation in treatment may help fix the problem. 

Recently, Canadian doctors looked at 359 patients and found that shared decision making between patients and doctors reduce the use of antibiotics for acute respiratory infections.

In shared decision making, a doctor and patient make a decision together based on evidence and patient preferences.

Antibiotics are often ineffective against acute respiratory infections because these infections are usually viral, therefore they’re not treatable with antibiotics. Experts believe that the overuse of antibiotics is contributing to an increase in antibiotic resistance, which is a major public health threat, according to the Centers for Disease Control and Prevention (CDC).

"Get involved in treatment decisions."

Patients who participated in the decision-making process regarding their treatment were less likely to decide to use antibiotics immediately after consultation, said Dr. France Légaré, from the Centre de recherche du Centre Hospitalier Universitaire de Québec and the Department of Family Medicine and Emergency Medicine at Université Laval in Québec.

In the study, 181 patients participated in shared decision making with 77 physicians in five family practice teaching units. These patients received a two-hour online tutorial followed by a two-hour interactive seminar about shared decision making.

Researchers also examined a control group of 178 patients who consulted 72 physicians in four teaching units who did not participate in shared decision making. These patients did not have access to the online tutorial and their doctors were asked to provide usual care.

Immediately after patients met with their doctors and either participated in making the decision or not, they were asked whether they chose antibiotics for treatment. Overall, 67 percent of the shared decision-making group felt they played an active role in decision making and 49 percent of the control group reported having an active role. The patients were asked two weeks later if they had stuck to their decision, had any regrets about their decision and about their quality of life.

Researchers found that the decision to use antibiotics was lower in patients who participated in shared decision making, as just 27.2 percent opted to use antibiotics.

Meanwhile, patients in the control group were more likely to use antibiotics, at 52.2 percent.

When the researchers circled back to the patients two weeks later, they found that the treatment strategy had no negative effect on the decision later, whether it was regretted or impacted a patient’s quality of life.

The researchers said that shared decision making enhanced patient participation, which led to a reduced use of a treatment option that in many cases will not benefit a patient.

They note that it’s possible to train physicians to engage patients in decision making and would be useful in emergency departments or to train nurses in helping patients make informed decisions.

This study was published in the Canadian Medical Association Journal.

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Review Date: 
July 25, 2012