Use shared decision-making to fight superbugs

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The concept of shared decision-making needn't just apply to major medical choices, such as whether a patient should undergo surgery or stop chemotherapy. Routinely involving patients in the decision process to treat everyday illnesses--particularly coughs, ear infections and sore throats--could add up to a big reduction in inappropriate use of antibiotics, suggests a new study published by the Cochrane Group.

Antibiotic stewardship is a topic of worldwide relevance, as drug-resistant superbugs become an increasingly deadly threat.

For the report, researchers reviewed 10 studies of more than 1,100 primary care physicians and nearly 500,000 patients throughout Europe and Canada, and compared how various physician communication strategies affected antibiotic prescribing. Overall, the analysis found that shared decision-making techniques reduced antibiotic prescribing for people with acute respiratory infections by almost 40 percent for up to six weeks.

Although the study designs could not completely eliminate bias or assess the longer-term effects of interventions such as communications training or giving patients more structured information, the researchers concluded there was moderate evidence to suggest such approaches were superior to usual care in reducing antibiotic prescribing for acute respiratory infections.

Indeed, some U.S. physicians have argued that in the absence of long-term solutions to the problem, such as breaking the paradigm of the 15-minute office visit and decreasing emphasis on patient satisfaction scores, physicians can influence patients themselves to become key antibiotic stewards, FiercePracticeManagement reported previously.

And while the authors of the Cochrane study acknowledged its imperfections, the general takeaway was that engaging the patient in the discussion certainly can't hurt.

"The time to act is now," wrote Alastair Hay, professor of primary care at the University of Bristol, in a commentary about the research in NIHR Signal. "In this reviewer's opinion, investment supporting the adoption of these interventions in the National Health Service is both timely and sensible and, because shared decision-making is a generic consultation skill, could result in wider benefits."

To learn more:
- see the abstract
- read the commentary

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