DECISION+, a Training Program to Improve Optimal Drug Prescription

NCT01116076 | Completed Phase 1

• 2 other identifiers: FRSQ2013135247
• Study Type: interventional
• Target: 712
• Locations: 1 country
• Sites: 1

Brief Summary

Decisions about the use of antibiotics for acute respiratory infections are the most frequently reported reason for consulting a family physician. Although it varies according to the specific type of acute respiratory infections, the use of antibiotics is estimated to be 63% to 67%, well above the expected prevalence of bacterial infections thus suggesting overuse of antibiotics. Consequently, there is an urgent need for helping family physicians and their patients to improve the clinical decision making process regarding the use of antibiotics for acute respiratory infections. We will evaluate the impact of DECISION +, a multifaceted intervention program that includes training in shared decision making, reminders and feedback targeting physicians, and decision support tools targeting patients on the decision to use antibiotics for acute respiratory infections. Results from this study will lay the ground for a national strategy targeting the improvement of the clinical decision making process regarding antibiotic use for acute respiratory infections in primary care. In turn, this will increase quality of care and patient safety.

Conditions

Acute Respiratory Infections

Outcome Measures

Primary Outcomes (1)

• Proportion of patients reporting a decision for "immediate antibiotics."

  After index consultation

Secondary Outcomes (6)

• Decision to use antibiotics

  After index consultation

• Decisional conflict

  After index consultation

• Adherence to the decision that was made

  2 weeks after the index consultation

• Decisional regret

  2 weeks after the index consultation

• Quality of life (QOL)

  Baseline and 2 weeks after the index consultation

Study Arms (2)

DECISION+ Program

EXPERIMENTAL

Exposure to the Decision+ Program

Behavioral: Decision+ program (to improve optimal drug prescription for ARI)

Control

NO INTERVENTION

Usual Care

Interventions

Decision+ program (to improve optimal drug prescription for ARI) BEHAVIORAL

DECISION+ is a multifaceted intervention program that includes: On site course and Internet-based courses (2x120 min), reminders of expected behaviours and feedback.

DECISION+ Program

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• All FP (teachers and residents) providing care in the walk-in clinic in each Family Practice Teaching Unit (FPTU) will be eligible to participate in the trial.

You may not qualify if:

• he/she was involved or participated in the DECISION + pilot RCT
• he/she is not expected to be practicing at the FPTU for the whole duration of the study (e.g. residents ending their residency program or doing rotations outside of the FPTU, planned pregnancy/delivery, planned retirement).
• PATIENTS:
• if 17 years old and under, must be accompanied by a parents or a guardians)
• they are consulting a participating physician for an ARI, for which treatment with an antibiotic is considered
• they are able (patients or the accompanying parent or guardians) to read, understand and write French (expected level: 8th grade)
• they give informed consent
• Patients with a condition requiring emergency care will be excluded.

Sponsors & Collaborators

• CHU de Quebec-Universite Laval: lead

Study Sites (1)

Centre Hospitalier Université Laval - Hôpital St-François d'Assise

Québec, Quebec, Canada

Location

Related Publications (4)

• Legare F, Labrecque M, Godin G, LeBlanc A, Laurier C, Grimshaw J, Castel J, Tremblay I, Fremont P, Cauchon M, Lemieux K, Rheaume C. Training family physicians and residents in family medicine in shared decision making to improve clinical decisions regarding the use of antibiotics for acute respiratory infections: protocol for a clustered randomized controlled trial. BMC Fam Pract. 2011 Jan 26;12:3. doi: 10.1186/1471-2296-12-3.

  PMID: 21269509 BACKGROUND

• Legare F, Labrecque M, Cauchon M, Castel J, Turcotte S, Grimshaw J. Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial. CMAJ. 2012 Sep 18;184(13):E726-34. doi: 10.1503/cmaj.120568. Epub 2012 Jul 30.

  PMID: 22847969 RESULT

• Legare F, Guerrier M, Nadeau C, Rheaume C, Turcotte S, Labrecque M. Impact of DECISION + 2 on patient and physician assessment of shared decision making implementation in the context of antibiotics use for acute respiratory infections. Implement Sci. 2013 Dec 26;8:144. doi: 10.1186/1748-5908-8-144.

  PMID: 24369771 DERIVED

• Guerrier M, Legare F, Turcotte S, Labrecque M, Rivest LP. Shared decision making does not influence physicians against clinical practice guidelines. PLoS One. 2013 Apr 24;8(4):e62537. doi: 10.1371/journal.pone.0062537. Print 2013.

  PMID: 23638111 DERIVED

Related Links

• Related Info

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Canada Research Chair in Implementation of Shared Decision Making in Primary Care

Study Record Dates

• First Submitted: May 3, 2010
• First Posted: May 4, 2010
• Study Start: May 1, 2010
• Primary Completion: April 1, 2011
• Study Completion: April 1, 2011
• Last Updated: February 1, 2013

Record last verified: 2013-01

Locations

CA (1)