It became clear that central to reducing antibiotic in primary care lies shared decision making (SDM). Australia falls behind many other western countries in adopting this method of introducing evidence to the consultation and sharing the decision making with the patient.
We have accordingly promoted SDM in the Australian literature (Hoffmann Med J Aust 2014;201:35-9), and through the NHMRC (Position Paper 2014).
We have undertaken a Cochrane review on SDM for antibiotic use in primary care consultations for acute respiratory infections (in press Coxeter 2015), that largely demonstrates they are effective.
Exploring the effect of prior beliefs of benefits and harms among the public find the benefits are over-estimated and the harms under-estimated (Hoffmann TC, Del Mar C. JAMA Int Med 2014;175:274-86). A similar review is underway about clinicians’ beliefs.
Similar findings are found among those with ARIs, (Hansen BMC Fam Pract 2015;16:82.
Prior beliefs are also important with respect to resistance (McCullough J Antimicrob Chemother2015doi:10.1093/jac/dkv164), and a similar review about public beliefs that are soon to be published.
One way of delivering SDM is using tools such as patient decision aids (PtDAs). We have been funded by the Australian Commission on Safety and Quality in Health care (ACSQHC) to develop a set of PtDAs in acute respiratory infections. This fits with the work of 2 PhDs students: Peter Coxeter is undertaking a trial of these PtDAs to test their acceptability with consumers. Mina Bakhit will trial trial the PDAs to test their effect on antibiotic prescribing.
The ACSQHC has also provided funding to develop an educational module on SDM for several professional Colleges.