Nivel, the Netherlands Institute for Health Services Research, BN Utrecht, The Netherlands.
Health Services Research Maastricht University, MD Maastricht, The Netherlands.
J Antimicrob Chemother. 2018 Nov 1;73(11):3199-3205. doi: 10.1093/jac/dky321.
Increasing antibiotic resistance is recognized as a major threat to global health and is related to antibiotic prescription rates in primary care. Shared decision-making (SDM), the process in which patients and doctors participate together in making decisions, is argued to possibly promote more appropriate use of antibiotics and reduce prescribing. However, it is unknown whether in practice fewer antibiotics are prescribed where more SDM takes place.
To investigate whether more SDM is related to less antibiotic prescribing and whether this relationship differs between subgroups of patients (male/female and age groups).
A questionnaire survey was conducted among 2670 members of the Dutch Health Care Consumer Panel to measure SDM (response rate 45%). Average practice-level SDM scores were calculated for 15 general practices. Data from routine electronic health records of 8192 adult patients of these general practices participating in the Nivel Primary Care Database were used to assess relevant illness episodes (acute cough, acute rhinosinusitis and urinary tract infection), the indication for antibiotics and antibiotic prescriptions. Logistic multilevel regression analyses were performed to investigate the relationship between practice-level SDM and patient-level antibiotic prescriptions.
In practices where more SDM takes place, general practitioners prescribed fewer antibiotics for adult patients under the age of 40 years in preference-sensitive situations (i.e. situations in which antibiotics could be considered according to clinical guidelines).
SDM can be a framework to reduce the prescribing of antibiotics and thus to control antibiotic resistance.
抗生素耐药性的不断增加被认为是对全球健康的主要威胁，而这与初级保健中的抗生素处方率有关。共同决策（SDM），即患者和医生共同参与决策的过程，被认为可能促进更合理地使用抗生素并减少处方量。然而，在实践中，SDM 实施越多是否会导致抗生素处方量减少尚不清楚。
调查 SDM 是否与抗生素处方量减少有关，以及这种关系是否因患者亚组（男性/女性和年龄组）而异。
对 2670 名荷兰医疗保健消费者小组的成员进行了问卷调查，以测量 SDM（应答率为 45%）。为 15 家普通诊所计算了平均实践水平 SDM 评分。使用这些普通诊所的 8192 名成年患者的常规电子健康记录中的数据来评估相关疾病发作（急性咳嗽、急性鼻-鼻窦炎和尿路感染）、抗生素的适应证和抗生素处方。进行逻辑多水平回归分析，以调查实践水平 SDM 与患者水平抗生素处方之间的关系。
在 SDM 实施较多的实践中，初级保健医生在偏好敏感情况下（即根据临床指南可以考虑使用抗生素的情况）为 40 岁以下的成年患者开具的抗生素处方较少。
SDM 可以作为减少抗生素处方的框架，从而控制抗生素耐药性。
