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

Area of Science:

• Public Health
• General Practice
• Infectious Disease Epidemiology

Background:

• Rising antibiotic resistance poses a significant global health threat, closely linked to primary care antibiotic prescribing rates.
• Shared decision-making (SDM) between patients and doctors is hypothesized to improve antibiotic prescribing appropriateness and reduce overall use.
• Empirical evidence on the relationship between the extent of SDM and actual antibiotic prescribing volumes in primary care is limited.

Purpose of the Study:

• To determine if increased shared decision-making (SDM) in general practices correlates with reduced antibiotic prescribing.
• To examine if this relationship between SDM and antibiotic prescribing varies across different patient demographic subgroups (gender, age).

Main Methods:

• A questionnaire survey assessed SDM among 2670 Dutch Health Care Consumer Panel members (45% response rate).
• Average SDM scores were calculated for 15 general practices.
• Antibiotic prescribing data for 8192 adult patients across common infection episodes (cough, rhinosinusitis, UTI) were extracted from electronic health records (Nivel Primary Care Database).
• Logistic multilevel regression analyses investigated the association between practice-level SDM and patient-level antibiotic prescriptions.

Main Results:

• Practices with higher levels of shared decision-making (SDM) demonstrated significantly lower rates of antibiotic prescriptions.
• This reduction in antibiotic prescribing associated with SDM was specifically observed in adult patients under 40 years old.
• The effect was noted in preference-sensitive situations, where antibiotic use is guided by clinical guidelines but not strictly mandatory.

Conclusions:

• Shared decision-making (SDM) serves as a valuable framework for optimizing antibiotic prescribing in primary care.
• Implementing SDM strategies can contribute to the reduction of antibiotic prescriptions, thereby aiding in the critical effort to combat antibiotic resistance.