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281 Use of a shared medical decision tool in the management of acute cystitis without risk of complication in general practice: comparison of antibiotic consumption between two randomised cluster groups
  1. Vincent Yves-Marie1,
  2. Dumont Guillaume1,
  3. Jacques Cornuz2,
  4. Guillaume Conort1,
  5. Thomas Ferté3,
  6. Jean-Phillipe Joseph1
  1. 1Department of general practice, University of Bordeaux, Bordeaux, France
  2. 2Center for Primary Gare and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
  3. 3Methodological Support Unit, University of Bordeaux, Bordeaux, France

Abstract

Introduction Simple cystitis is a common urinary tract infection, affecting between 40% and 60% of women in their lifetime. The risk of complications is very rare and the intensity of symptoms varies according to the infection and the patient, but the treatment recommended by learned societies is very often systematic antibiotic therapy. We have previously designed a tool to aid shared medical decision-making regarding the use of antibiotics for uncomplicated cystitis. The primary objective of this study was to compare antibiotic consumption over 14 days between standard practice and the use of a shared medical decision support tool.

Method We conducted a multicentre, comparative, cluster-randomised clinical trial in two parallel groups: one group using the good practice recommendations of the French lnfectious Diseases Society and the other using the decision support tool during the consultation. A qualitative study with semi-structured interviews using grounded theory with double coding was carried out following use of the tool to assess the factors influencing its implementation.

Results Between June 2020 and November 2021, we included 167 patients. There were 42 patients recruited in the tool group, compared with 135 in the group applying the recommendations, despite the same number of investigators. The antibiotic consumption rate was 89.5% compared with 96.7% between DO and 0 14. The group using the tool prescribed antibiotics 89.7% of the time compared with 100% in the recommendation group, and prescribed delayed antibiotics 42.9% of the time compared with 8.1% in the recommendation group.

Discussion and Conclusion The use of a shared medical decision support tool for uncomplicated cystitis in primary care appears to encourage a reduction in antibiotic prescribing and delayed antibiotic prescribing, without presenting any significant risk for patients.

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