Does shared decision making reduce antibiotics prescribing in primary care?

In practices where more shared decision making takes place, general practitioners prescribe fewer antibiotics for young adult patients in situations in which antibiotics could be considered according to clinical guidelines. This is shown by research of Nivel, using data from routine electronic health records and a questionnaire survey. Reducing inappropriate antibiotic use is important, since antibiotic use is related to antibiotic resistance, which is recognized as a major threat to global health.

Interventions that promote shared decision making have been shown to reduce rates of antibiotic prescription in primary care in the short term. The present study shows that in practices where more shared decision making (SDM) takes place, fewer antibiotics are prescribed for patients under 40 years old in situations in which antibiotics could be considered. These results are published in the Journal of Antimicrobial Chemotherapy.

Fewer antibiotics in preference-sensitive situations
Shared decision making is the process in which patients and doctors make decisions together. It provides an opportunity to consider the trade-off between benefit and harm of antibiotics. This is especially valuable when deciding between preference-sensitive options: decisions that depend on patient preferences because clinical evidence does not clearly support one of the options. In the context of prescribing antibiotics in primary care, situations for which clinical guidelines do not give clear recommendations to prescribe antibiotics or not can be considered preference-sensitive. The Nivel study shows that in those situations, fewer antibiotics are prescribed in practices where more shared decision making takes place.

Shared decision making only related to antibiotics prescribing to young adults
The relation between shared decision making and antibiotics prescribing was only found for adult patients under the age of 40. Nivel researcher Thamar van Esch: ‘Previous studies indicate that GP’s think that elderly patients prefer to be less involved in decision making and that they more often expect antibiotics than younger patients. Additionally, there can be uncovered clinical reasons for more antibiotics prescriptions for patients over 65 years. It remains unclear why no relation is found between shared decision making and antibiotics prescribing in the group of patients aged 40-64 .’

Research using routine electronic health records and a questionnaire survey
Nivel researchers used linked data from the Nivel Primary Care Database and the Dutch Health Care Consumer Panel. Out of 15 general practices that participate in the Nivel Primary Care Database, approximately 2.700 members of the Dutch Health Care Consumer Panel were requested to fill out a questionnaire on shared decision making. Data from routine electronic health records of all patients of the 15 practices with acute cough, acute rhinosinusitis and urinary tract infection, were used to assess information about antibiotics prescribing.

This research project relates to Nivel's research program Pharmaceutical Care (lead by prof. Liset van Dijk, PhD).