Towards shared decision making: exploring new ways of communicating evidence to patients about benefits and harms of antibiotics for acute respiratory infections.

Abstract

Acute respiratory infections (ARIs) are one of the most common reasons for consultations in primary care and receiving an antibiotic, despite good evidence that they confer only marginal benefit and that these benefits may be outweighed by harms, as well as the potential contribution to antibiotic resistance. Antibiotic resistance is the ability of bacteria to naturally adapt to antibiotics used to treat them and reduces their effectiveness, and is now a global threat to public health. Potentially modifiable factors contributing to primary care prescribing of antibiotics for ARIs include diagnostic uncertainty, perceived and expressed patient expectations for an antibiotic, and a clinician’s desire to maintain patient satisfaction. Patients’ misperceptions of antibiotic benefits and harms may also be a contributor to requests for antibiotics. These factors suggest a need to improve clinician and patient communication during consultations. Parents should be a particular focus, as children experience ARIs more frequently and are more likely to receive an antibiotic. With its focus on communication, discussing benefits and harms, and encouraging collaborative decision making, shared decision making may be an appropriate strategy for improving informed patient/parent choice about antibiotics for ARIs and reducing their use. This thesis aimed to explore the appropriateness of using shared decision making to promote informed choice by patients as a strategy which may lead to reduced antibiotic use for ARIs in Australian primary care, with a particular focus on children. Shared decision making appears to be an appropriate and effective strategy for improving parents’ informed choice about antibiotic use for a child’s ARI, and one that is desired by and acceptable to parents. Patient decision aids are a tool that can be used to facilitate the process of shared decision making and improve communication between clinicians and patients. This thesis has explored the appropriateness of shared decision making as a strategy to reduce unnecessary antibiotic prescribing for ARIs in primary care, and developed patient decision aids as a tool to assist its implementation. The research conducted as part of this thesis has answered a number of previously unknown questions and may lead to the reduction of antibiotic prescribing for ARIs in primary care.

Date of Award	17 Feb 2018
Original language	English
Supervisor	Tammy Hoffmann (Supervisor) & Christopher Bernard Del Mar (Supervisor)