Keywords: medical education, patient ecudcation, shared decision making, patient communication
If primary care physicians (PCP) prescribe fewer antibiotics, this should reduce the rate of antibiotic resistance. PCP prescribe fewer antibiotics when they engage in shared decision making (SDM) with their patients, which encourages patients to express their preferences and receive treatment that aligns with their values. Effective SDM tools for antibiotic prescription in primary care should thus be developed, tested, and integrated into daily routine practice.
We developed and tested evidence-based summary information (EBSI) for PCP and SDM instruments over four Plan-Do-Study-Act (PDSA) cycles conducted with quality circles (QC) as an intervention for QCs to reduce antibiotic prescription rate. The EBSI and SDM instruments addressed the clinical problem of otitis media acuta, tonsillopharyngitis, and (in women) lower urinary tract infection. We began by retrieving evidence-based information and finding existing patient decision aids in the literature for these infections. PCPs gave us feedback on the documents in 2 QC sessions. We developed a questionnaire to capture PCPs’ knowledge before the first QC and after the second QC, received feedback from expert physicians and interviewed patients to improve the documents.
Three QC (39 PCP) participated in two out of four PDCA cycles. Six expert physicians commented on the EBSI and SDM instruments. We interviewed 11 patients in separate one-hour interviews. Most PCPs appreciated the developed QC intervention, though role plays revealed they found it hard to implement SDM.The EBSI in QC increased PCP knowledge and interviewed patients appreciated the SDM instrument.
While both PCP and patients appreciated the developed tools, future efforts should enable PCP to be more confident about the current evidence and PCP need to practice communication skills in the safe environment of a QC to become familiar with the process of SDM. We plan on testing the impact of this intervention on antibiotic prescriptions patterns.