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Les infections aiguës des voies respiratoires supérieures (IVRS) telles que l’otite moyenne, la rhinosinusite, la pharyngite et la bronchite aiguës constituent jusqu’à 10% des raisons de consultation dans les départements d’urgence (1). Plusieurs études ont documenté que ces infections sont en large majorité d’étiologie virale et donc auto-résolutives. Bien que l'antibiothérapie soit inutile dans le traitement des infections respiratoires aiguës d’étiologie virale, le recours à l’antibiothérapie est encore largement répandu auprès des cliniciens d’Amérique du Nord (2). La prise inappropriée d’antibiotiques est associée à la résistance aux antibiotiques, à un risque augmenté d’effets secondaires et a un plus haut taux de réadmission (3). C’est un problème majeur de santé publique (4)(5). 

Les outils d’information se présentent comme une solution prometteuse pour mieux informer le les patients et les médecins sur cette problématique. Les outils d’information peuvent soutenir une prise de décision éclairée concernant une question de santé individuelle. Cela peut ouvrir le dialogue pour une prise de décision partagée entre le patient et le médecin.  La prise de décision partagée est un processus décisionnel où le médecin, le patient et son entourage partagent des informations instruites par le meilleur niveau de données probantes, évaluent toutes les options diagnostiques et thérapeutiques possibles, identifient les priorités du patient, délibèrent et décident conjointement de la meilleure prise en charge pour le patient.

Bibliographie

1. Hing E, Cherry DK, Woodwell DA. National Ambulatory Medical Care Survey: 2004 summary. Adv Data. 2006 Jun 23;(374):1–33

2. Murphy - Journal of Emergency Medicine RA, 2016. Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011. jem-journal.com [Internet]. 2016; Available from: www.jem-journal.com/article/S0736-4679(16)30470-X/abstract

3. Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014 Dec;5(6):229–41.

4. Opatowski M, Cosker K, Brun-Buisson C, Tuppin P, Salomon J, Watier L. Résistance bactérienne aux antibiotiques, apport du PMSI. Revue d’Épidémiologie et de Santé Publique. 2017 Mar 1;65(Supplement 1):S12.

5. Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T. 2015 Apr;40(4):277–83.

Projets:

Opens internal link in current windowAntibiotiques en soins primaires: DÉCISION+

Opens internal link in current windowAntibiotiques en médecine d'urgence

Ressources supplémentaires:

http://ici.radio-canada.ca/nouvelle/1066443/surutilisation-ordonnance-antibiotiques-canada-institut-information-sante-icis

http://presse.inserm.fr/les-antibiotiques-perturbent-lefficacite-de-limmunotherapie/29901/

http://www.who.int/campaigns/world-antibiotic-awareness-week/fr/

https://choisiravecsoin.org/wp-content/uploads/2017/10/ThreeQuestions-FR.pdf

http://www.who.int/features/qa/75/fr/index.html

http://www.who.int/entity/mediacentre/factsheets/fs194/fr/index.html

http://www.who.int/entity/mediacentre/factsheets/antibiotic-resistance/fr/index.html

http://www.who.int/features/factfiles/antimicrobial_resistance/fr/index.html

http://www.who.int/entity/campaigns/world-antibiotic-awareness-week/quiz/fr/index.html

https://www.canada.ca/fr/sante-publique/services/resistance-aux-antibiotiques-antimicrobiens.html

https://www.canada.ca/fr/sante-publique/services/resistance-aux-antibiotiques-antimicrobiens/materiel-sensibilisation-resistance-aux-antibiotiques.html

 

 

 

Antibiotics in primary care: Decision+

 

DECISION+ is an innovative training program for physicians. It integrates multiple educational/behavioral change components that aim at promoting shared decision making with respect to treatment option. We hypothesize that shared decision making should result in optimal use of medication by patients.


 

Pilot Study

The objective of DECISION+ pilot RCT was to evaluate the feasibility of a larger trial, in order to determine the program's efficacy to promote optimal use of antibiotics for ARI.

Preview of DECISION+:

  • Training session
    • This power point presentation is a summary of the DECISION+ pilot training program. It was presented as a workshop at the 5th International Shared Decision Making Conference which took place June 14-17 2009 in Boston, MA, USA.
  • Decision support tool

DECISION+ pilot study related publications: 

Leblanc A, Légaré F, Labrecque M, Godin G, Thivierge R, Laurier C, Côté L, O'Connor AM, Rousseau M. Feasibility of a randomized trial of a continuing medical education program in shared decision making on the use of antibiotics for acute respiratory infections in primary care: The DECISION+ pilot trial. Implement Sci. 2011 Jan 18;6(1):5

Légaré F, Labrecque M, Leblanc A, Njoya M, Laurier C, Côté L, Godin G, Thivierge RL, O'Connor AM, St-Jacques S. 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(1):96-110.

Allaire AS, Labrecque M, Giguère A, Gagnon MP, Grimshaw J, Légaré F. Barriers and facilitators to the dissemination of DECISION+, a continuing medical education program for optimizing decisions about antibiotics for acute respiratory infections in primary care: A study protocol. Implement Sci. 2011 Jan 7;6(1):3

Légaré F, Labrecque M, Leblanc A, Thivierge R, Godin G, Laurier C, Côté L, O'Connor AM, Allain-Boulé N, Rousseau J, Tapp S. Does training family physicians in shared decision making promote optimal use of antibiotics for acute respiratory infections? Study protocol of a pilot clustered randomized controlled trial. BMC Fam Pract. 2007 Nov 29;8:65.


DECISION+2 randomized control trial

This project, to be carried out from 2009 to 2012, will use as a baseline the data gathered during our pilot program. The pilot’s main goal was to establish the feasibility of conducting the project at a larger scale. Therefore, the current project will assess the impact of DECISION+2 on antibiotics use for acute respiratory infections (ARI) – the main reason for medical consultations in a large sample of family medicine teaching practices. 

This project is being funded by the FRSQ-Conseil du Medicament.

DECISION+2 randomized control trial related publications:

Couët N, Labrecque M, Robitaille H, Turcotte S, Légaré F. The impact of DECISION+2 on patient intention to engage in shared decision making: Secondary analysis of a multicenter clustered randomized trial. Submitted to Health Expectations.

Turcotte S, Guerrier M, Labrecque M, Robitaille H, Rivest LP, Hess B, Légaré F. Dyadic validity of the Decisional Conflict Scale for patients and their physicians. Submitted to the Journal of Clinical Epidemiology.

Ferron Parayre A, Labrecque M, Rousseau M, Turcotte S, Legare F. Validation of SURE, a four-item clinical checklist for detecting decisional conflict in patients. Medical decision making: an international journal of the Society for Medical Decision Making. 2014 Jan;34(1):54-62. 

Giguere A, Labrecque M, Njoya M, Thivierge R, Legare F. Development of PRIDe: A tool to assess physicians' preference of role in clinical decision making. Patient Education and Counseling. 2012 Aug;88(2):277-83

Légaré F, Labrecque M, Cauchon M, Castel J, Turcotte S, Grimshaw J.Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial.2012/05/01. Eng. CMAJ. 2012 Sep 18;184(13):E726-34. 

Allaire AS, Labrecque M, Giguere A, Gagnon MP, Legare F. What motivates family physicians to participate in training programs in shared decision making? The Journal of Continuing Education in the Health Professions. 2012 Mar;32(2):98-107. 

Légaré F, Guerrier M, Nadeau C, Rhéaume C, Turcotte S, Labrecque M. Impact of DECISION + 2 on patient and physician assessment of shared decision making implementation in the context of antibiotics use for acute respiratory infections. Implement Sci. 2013 Dec 26;8:144.

Ferron Parayre ALabrecque MRousseau MTurcotte SLégaré F. Validation of SURE, a four-item clinical checklist for detecting decisional conflict in patients. Med Decis Making 2013 Jun 17.

Leblanc A, Legare F, Labrecque M, Godin G, Thivierge R, Laurier C, et al. Feasibility of a randomised trial of a continuing medical education program in shared decision-making on the use of antibiotics for acute respiratory infections in primary care: the DECISION+ pilot trial. Implementation Science : IS. 2011;6:5.

Guerrier MLégaré FTurcotte SLabrecque MRivest LP. Shared decision making does not influence physicians against clinical practice guidelines. PLoS One 2012; 8(4):e62537.

Allaire ASLabrecque MGiguere AGagnon MPLégaré F. What motivates family physicians to participate in training programs in shared decision making? J Contin Educ Health Prof 2012; 32(2):98-107.

Légaré F, Labrecque M, Cauchon M, Castel J, Turcotte S, Grimshaw J. Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial. CMAJ. 2012 Sep 18; 184(13):E726-34.

Légaré F, Labrecque M, Godin G, Leblanc A, Laurier C, Grimshaw J, Castel J, Tremblay I, Frémont P, Cauchon M, Lemieux K, Rhéaume C. Training family physicians and residents in family medicine in shared decision making to improve clinical decisions regarding the use of antibiotics for acute respiratory infections: protocol for a clustered randomized controlled trial. BMC Fam Pract. 2011 Jan 26;12(1):3

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