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blog > Posts > Antibiotic Awareness Week 2018
November 12
Antibiotic Awareness Week 2018

11/12/18

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Let's talk about antibiotics - Shared decision making

PHO is calling on prescribers, nurses, pharmacists and healthcare providers to change the way we talk about antibiotics for common acute respiratory tract infections (ARTI), including bronchitis, pharyngitis, sinusitis and otitis media.

In today’s era of rising antibiotic resistance, it is not appropriate to routinely use antibiotics “just in case.” In fact, for most patients with an ARTI, antibiotics pose more harm than good.

Conversations between patients and clinicians about when NOT to use antibiotics are growing. 

In partnership with Choosing Wisely Canada, PHO has developed a series of new resources, entitled "Let's Talk", encouraging clinicians to adopt a shared decision making (SDM) approach when having these conversations.

What is shared decision making?

SDM is a patient-centered conversation focused on the benefits and harms of treatment options and patient expectations, with the ultimate goal of informing a joint decision between the clinician and patient. SDM is an effective means of knowledge translation, where the patient is the expert in their own life situation and preferences, while the clinician in the expert in clinical evidence.1

Why practice shared decision making?

ARTIs are associated with the most inappropriate antibiotic use in primary care.2 Interventions and tools that facilitate SDM have been shown to reduce antibiotic prescribing in primary care without decreasing patient satisfaction or worsening patient health outcomes.3,4 Patients often mistake the effectiveness of antibiotics5,6, while prescribers often overestimate the expectation for antibiotics.7,8,9 SDM helps both parties clearly define the role of antibiotics and align expectations for treatment.

How can the "Let's Talk" resources be used in your practice?

Do you think you need antibiotics? includes 5 questions to encourage patients to understand the benefits and harms of antibiotics, and to discuss what matters most to them with their health care provider.

To improve understanding about the role of antibiotics in viral respiratory illnesses, clinicians can refer to these evidence-based resources to complement their discussions about the benefits and harms of antibiotics:

Do you think you need antibiotics?

Bronchitis

Sore Throat

Sinus Infection

Ear Infection​


Are you interested in learning more? Join us for our November 13 webinar!

Shared decision making and antibiotic use in primary care

During this webinar, Dr. France Légaré will discuss using shared decision making to reduce unnecessary antibiotic use in primary care. She will review barriers and facilitators to implement shared decision making in your practice, and how shared decision making can be used to discuss decisions about antibiotics for patients with an acute respiratory tract infection. 

Date: November 13, 2018

Time: 12:00 p.m. - 1:00 p.m. 

Registration​


For more information about antimicrobial stewardship check out these ASP resources.

Explore what organizations around the world are doing for Antibiotic Awareness Week:

·         Choosing Wisely: Using Antibiotics Wisely

·         National Collaborating Centre for Infectious Diseases: Antibiotic Awareness Week (Canada)

·         World Health Organization: World Antibiotic Awareness Week

·         US Centers for Disease Control and Prevention: Antibiotic Awareness Week (USA)

·         Australian Commission on Safety and Quality in Healthcare: Antibiotic Awareness Week (Australia)

·         European Centre for Disease Control and Prevention: European Antibiotic Awareness Day


References:

1.       Butler CC, Kinnersley P, Prout H, Rollnick S, Edwards A, Elwyn G. Antibiotics and shared decision-making in primary care. J Antimicrob Chemother. 2001;48(3):435-40. Available from: https://academic.oup.com/jac/article/48/3/435/736084

2.       Shively NR, Buehrle DJ, Clancy CJ, Decker BK. Prevalence of inappropriate antibiotic prescribing in primary care clinics within a veterans affairs healthcare system. Antimicrob Agents Chemother. 2018;62(8):e00337-18. Available from: https://aac.asm.org/content/62/8/e00337-18.long

3.    Coxeter P, Del Mar CB, McGregor L, Beller EM, Hoffman TC. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database Syst Rev. 2015;(11):CD010907. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010907.pub2/full

4.     Légaré F, Labrecque M, LeBlanc A, Njoya M, Laurier C, Côté L, et al. Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections: a pilot clustered randomized controlled trial. Health Expect. 2011;14 Suppl 1:96-110. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1369-7625.2010.00616.x

5.       Davey P, Pagliari C, Hayes A. The patient’s role in the spread and control of bacterial resistance to antibiotics. Clin Microbiol Infect. 2002;8 Suppl 2:43-68. Available from: https://onlinelibrary.wiley.com/doi/full/10.1046/j.1469-0691.8.s.2.6.x

6.     Mangione-Smith R, McGlynn EA, Elliott MN, Krogstad P, Brook RH. The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior. Pediatrics. 1999;103(4 Pt 1):711-8.

7.     Stivers T, Mangione-Smith R, Elliott MN, McDonald L, Heritage J. Why do physicians think parents expect antibiotics? What parents report vs what physicians believe. J Fam Pract. 2003;52(2):140-8.

8.       McNulty CAM, Nichols T, French DP, Joshi P, Butler CC. Expectations for consultations and antibiotics for respiratory tract infection in primary care: the RTI clinical iceberg. Br J Gen Pract. 2013;63(612):e429-36. Available from: https:/bjgp.org/content/63/612/e429.long

9.      Mangione-Smith R, McGlynn EA, Elliott MN, McDonald L, Franz CE, Kravitz RL. Parent expectations for antibiotics, physician-parent communication, and satisfaction. Arch Pediatr Adolesc Med. 2001;155(7):800-6. Available from: https://jamanetwork.com/journals/jamapediatrics/fullarticle/190801


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