Does shared decision-making reduce antibiotic prescribing in primary care?

Autor: Thamar E M van Esch, Anne E. M. Brabers, Judith D. de Jong, Robert A Verheij, Liset van Dijk, Karin Hek
Přispěvatelé: RS: CAPHRI - R2 - Creating Value-Based Health Care, Health Services Research
Rok vydání: 2018
Předmět:
Adult
Male
0301 basic medicine
Microbiology (medical)
medicine.medical_specialty
EUROPE
Adolescent
Databases
Factual
Patients
medicine.drug_class
Clinical Decision-Making
General Practice
030106 microbiology
Antibiotics
Primary care
Drug Prescriptions
Young Adult
03 medical and health sciences
PHYSICIANS
0302 clinical medicine
Antibiotic resistance
General Practitioners
Surveys and Questionnaires
Health care
medicine
Global health
Humans
Pharmacology (medical)
030212 general & internal medicine
Practice Patterns
Physicians'
Medical prescription
Respiratory Tract Infections
Aged
Netherlands
Pharmacology
Response rate (survey)
Primary Health Care
business.industry
Questionnaire
Middle Aged
Anti-Bacterial Agents
Infectious Diseases
Family medicine
Female
Guideline Adherence
CLINICAL-PRACTICE GUIDELINES
business
RESISTANCE
Zdroj: Journal of Antimicrobial Chemotherapy, 73(11), 3199-3205. Oxford University Press
ISSN: 1460-2091
0305-7453
DOI: 10.1093/jac/dky321
Popis: Background Increasing antibiotic resistance is recognized as a major threat to global health and is related to antibiotic prescription rates in primary care. Shared decision-making (SDM), the process in which patients and doctors participate together in making decisions, is argued to possibly promote more appropriate use of antibiotics and reduce prescribing. However, it is unknown whether in practice fewer antibiotics are prescribed where more SDM takes place. Objectives To investigate whether more SDM is related to less antibiotic prescribing and whether this relationship differs between subgroups of patients (male/female and age groups). Patients and methods A questionnaire survey was conducted among 2670 members of the Dutch Health Care Consumer Panel to measure SDM (response rate 45%). Average practice-level SDM scores were calculated for 15 general practices. Data from routine electronic health records of 8192 adult patients of these general practices participating in the Nivel Primary Care Database were used to assess relevant illness episodes (acute cough, acute rhinosinusitis and urinary tract infection), the indication for antibiotics and antibiotic prescriptions. Logistic multilevel regression analyses were performed to investigate the relationship between practice-level SDM and patient-level antibiotic prescriptions. Results In practices where more SDM takes place, general practitioners prescribed fewer antibiotics for adult patients under the age of 40 years in preference-sensitive situations (i.e. situations in which antibiotics could be considered according to clinical guidelines). Conclusions SDM can be a framework to reduce the prescribing of antibiotics and thus to control antibiotic resistance. (aut. ref.)
Databáze: OpenAIRE
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