Shared decision-making does not decrease antibiotic prescribing

Reference

Hoffmann TC, Jones M, Glasziou P, Beller E, Trevena L, Mar CD. A brief shared decision-making intervention for acute respiratory infections on antibiotic dispensing rates in primary care: a cluster randomized trial. Ann Fam Med 2022;20(1):35-41.

Synopsis

To see if a brief shared decision-making intervention would decrease antibiotic prescriptions for acute respiratory tract infections, these authors conducted a cluster randomized trial in which they randomized Australian primary care practices to provide intervention (n = 13 practices, 69 clinicians) or control (n = 14 practices, 52 clinicians). The intervention was relatively sophisticated, yet brief. It consisted of 3 separate decision aids for patients (acute otitis media, sore throat, and acute bronchitis) and a 15-minute training video for the clinicians. The control practices did not receive the intervention during the study period. The researchers used intention to treat to analyze changes in the rate of antibiotic dispensing for specific antibiotic classes (cephalosporins, penicillins, macrolides) for the 12 months before and the 12 months after the intervention. The baseline rates of targeted antibiotic dispensing were 3.5% in the intervention practices and 3.2% in the control practices. During the follow-up interval, the rates decreased by a similar degree in both groups (2.9% vs 2.6%, respectively). The link between clinician knowledge and clinician behavior continues to be very disappointing: Although the clinicians' knowledge improved, their prescribing didn’t change. The clinicians also reported that the use of aids (even brief ones) to guide shared decision-making were time-consuming and they believed they were already using shared decision-making.