Introduction In Switzerland, primary care physicians (PCP) often disregard guideline recommendations and prescribe antibiotics to treat self-limiting infections,^1–3 but when PCPs who participated in quality circles (QC) were informed by the latest evidence and taught to use shared decision-making (SDM), antibiotic prescription rates fell.^4–6 We thus developed educational evidence-based summary information (EBSI) and clinical encounter support tools (CEST) to reduce antibiotic prescriptions for the infections that account for 80% of outpatient antibiotic prescriptions⁷ and tested their applicability and usability in practice.

Method A scoping search informed the initial draft of tools based on SDM’s program theory and taxonomy of behaviour change techniques.^{8 9}From Oct 2020 to Nov 2021, we gathered feedback from 3 focus groups (46 PCPs) in two QC sessions and interviewed 11 patients and 6 experts in infectiology and SDM to improve and test the documents. We surveyed participating PCPs before and after the focus group sessions to measure the increase in their knowledge.

Results Most PCPs (40/46) said they would use the final versions because the EBSIs would be useful in daily practice and the CEST would help them transfer knowledge to patients during SDM. PCPs were not confident of their SDM skills and felt they needed more training. PCPs self-reported that their knowledge increased, correlating with our survey results. Patients were satisfied with the counselling process and our experts confirmed our documents were accurate.

Discussion PCPs and patients appreciated the EBSIs and CESTs, but need more training within their QCs to increase their confidence in their SDM and communication skills.

Conclusion We worked with stakeholders to successfully develop, adapt, and test tools that encourage PCPs to engage in SDM about antibiotic prescriptions and will conduct further research to determine if using the tools reduces antibiotic prescription rates.

References

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2. Glinz D, Leon Reyes S, Saccilotto R, et al. Quality of antibiotic prescribing of swiss primary care physicians with high prescription rates: a nationwide survey. The Journal of antimicrobial chemotherapy. Nov 1 2017;72(11):3205–3212. doi:10.1093/jac/dkx278.

3. Müller-Brodmann DH, Dagmar. Swiss Antibiotic Resistance Report 2020; Usage of Antibiotics and Occurence of Antibiotic Resistance in Switzerland. 2020; Swiss Antibiotic Resistance Report. November 2020.

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5. Coxeter P, Del Mar CB, McGregor L, Beller EM, Hoffmann TC. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database of Systematic Reviews. 2015; doi:10.1002/14651858.cd010907.pub2.

6. Van Esch TEM, Brabers AEM, Hek K, van Dijk L, Verheij RA, de Jong JD. Does shared decision-making reduce antibiotic prescribing in primary care? The Journal of antimicrobial chemotherapy. Nov 1 2018;73(11):3199–3205. doi:10.1093/jac/dky321.

7. Daouk S, Heim D, Kronenberg AO, et al. Swiss Antibiotic Resistance Report 2022; Usage of antibiotics and occurrence of antibiotic resistance in switzerland. 2022.

8. Agbadjé TT, Elidor H, Perin MS, Adekpedjou R, Légaré F. Towards a taxonomy of behavior change techniques for promoting shared decision making. Implementation Science. 2020;15(1). doi:10.1186/s13012-020-01015-w.

9. Waldron T, Carr T, McMullen L, et al. Development of a program theory for shared decision-making: a realist synthesis. BMC Health Serv Res. Jan 23 2020;20(1):59. doi:10.1186/s12913-019-4649-1.