Acevedo Callejas Michelle L, Zhou Yanmengqian, Farrell Erina L, Foley Kasey A
Department of Communication Arts & Sciences, Pennsylvania State University, University Park, USA.
Department of Communication Studies, Louisiana State University, Baton Rouge, USA.
Patient Educ Couns. 2023 Mar;108:107619. doi: 10.1016/j.pec.2022.107619. Epub 2022 Dec 31.
Strategies that assist patients with upper respiratory tract infections (URTIs) to endorse non-antibiotic treatments are vital to curbing antibiotic resistance. This study examines the potential of shared decision-making (SDM) for improving stewardship-relevant outcomes and investigates patient affect as a mechanism that explains the beneficial impact of perceived SDM.
Patients (N = 433) seeking care for URTIs at a university student health center and not prescribed antibiotics completed a pre-visit questionnaire and two surveys one day and 14 days post-visit. The day-one survey assessed perceived SDM, affect, and immediate stewardship-relevant outcomes, and the day-14 survey assessed long-term stewardship-relevant outcomes.
Perceived SDM was negatively associated with negative affect and positively associated with positive affect, favorable perceptions of non-antibiotic treatments and providers, and self-efficacy to manage symptoms and obtain follow-up care. Patient affect and day-one outcomes were mediators between perceived SDM and retrospective self-efficacy two weeks post-visit.
The study illustrated the beneficial influence of patient perceived SDM on antibiotic stewardship in both short and long terms and elucidated the mechanisms through which the influence occurs.
SDM can be an effective strategy for primary care providers to improve patients' outcomes with URTI visits without prescribing unwarranted antibiotics.
帮助上呼吸道感染（URTI）患者认可非抗生素治疗的策略对于遏制抗生素耐药性至关重要。本研究探讨了共同决策（SDM）在改善与管理相关结局方面的潜力，并调查了患者情感作为解释感知到的SDM有益影响的一种机制。
在大学生健康中心寻求URTI治疗且未开具抗生素处方的患者（N = 433）在就诊前完成一份问卷，并在就诊后1天和14天完成两项调查。第一天的调查评估了感知到的SDM、情感以及与管理相关的即时结局，第14天的调查评估了与管理相关的长期结局。
感知到的SDM与消极情感呈负相关，与积极情感、对非抗生素治疗和医疗服务提供者的良好认知以及管理症状和获得后续护理的自我效能呈正相关。患者情感和第一天的结局是就诊后两周感知到的SDM与回顾性自我效能之间的中介因素。
该研究阐明了患者感知到的SDM在短期和长期对抗生素管理的有益影响，并阐明了这种影响发生的机制。
对于初级保健提供者而言，共同决策可以成为一种有效的策略，在不开具不必要抗生素的情况下改善患者URTI就诊的结局。
