Shared decision making reduces antibiotic use




Shared decision making between doctors and patients for the treatment of acute respiratory infections can achieve significant short-term reductions in antibiotic use, according to a Cochrane review published Nov. 11.

“Shared decision making is … a set of communication and evidence-based practice skills that elicits patients’ expectations, clarifies any misperceptions, and discusses the best available evidence for benefits and harms of treatment,” wrote Peter Coxeter of the Centre for Research in Evidence-Based Practice at Bond University, Australia.


Dr. Coxeter and his coauthors analyzed 10 published reports from nine randomized controlled trials involving more than 1,100 physicians and 492,000 patients, and found that shared decision making interventions were associated with a 39% overall reduction in antibiotic use (95% confidence interval, 0.55-0.68) within 6 weeks of the consultation, with a trend suggesting those reductions were maintained in the longer term.

The analysis also showed that this reduction did not lead to an increase in patient-initiated reconsultations or a decrease in patient satisfaction, although there were not enough data to determine the impact of these interventions on longer-term outcomes such as hospital admissions, pneumonia, or mortality (Cochrane Database Syst Rev. 2015 Nov 11. doi: 10.1002/14651858.CD010907.pub2).

“Further research should also aim to determine which aspects of these interventions provide the greatest benefit to adapt program implementation and uptake in diverse clinical settings,” the authors wrote.

The review was supported by the National Health and Medical Research Council (Australia). No conflicts of interest were declared.

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