D espite recent efforts to decrease the use of antibiotics for acute respiratory infections, their prescription is still too frequent 1,2 and may be contributing to antibiotic resistance. 1 Only 6%-18% of children with acute respiratory infections, 5%-15% of adults with pharyngitis and 38% of adults with acute rhinosinusitis have bacterial infections. 3,4 Studies investigating improvement in clinical decision-making about the use of antibiotics for acute respiratory infections have been inconclusive, and interventions to reduce their use have shown only moderate success. 5 In the shared decision-making model, a health care professional and the patient make a decision together based on the best available evidence and the patient's values and preferences. 6 Shared decision-making is recognized as an effective strategy for reducing the overuse of treatment options not clearly associated with benefits for all patients. 7 In a randomized pilot trial, we showed that an earlier version of the training program in shared decision-making (DECISION+) reduced the proportion of patients who decided to use antibiotics immediately after consulting for acute respiratory infections (control 49%, DECISION+ 33%; absolute difference 16%; p = 0.08), a reduction that was maintained 6 months later. 8 However, because only 46% of enrolled providers in the pilot trial participated in all three 3-hour workshops, we improved the training program before conducting a definitive trial. 9 Following an in-depth evaluation with participants in the pilot trial, 10,11 we modified the training program and renamed it DECISION+2. In the current study, we evaluated its effect on the proportion of patients who decided to use antibiotics for acute respiratory infections after physician consultation. Background: Few interventions have proven effective in reducing the overuse of antibiotics for acute respiratory infections. We evaluated the effect of DECISION+2, a shared decision-making training program, on the percentage of patients who decided to take antibiotics after consultation with a physician or resident.

Purpose The Continuing Professional Development Center of the Faculty of Medicine at Laval University offers an internet-based program on evidence-based medicine (EBM). After one year, only three physicians out of the 40 who willingly paid to register had completed the entire program. This descriptive study aimed to identify physicians' beliefs regarding their completion of this online program. Methods Using theoretical concepts from the Theory of Planned Behaviour, a semi-structured telephone interview guide was developed to assess respondents' attitudes, perceived subjective norms, perceived obstacles and facilitating conditions with respect to completing this internet-based program. Three independent reviewers performed content analysis of the interview transcripts to obtain an appropriate level of reliability. Findings were shared and organised according to theoretical categories of beliefs.Results A total of 35 physicians (88% response rate) were interviewed. Despite perceived advantages to completing the internet-based program, barriers remained, especially those related to physicians' perceptions of time constraints. Lack of personal discipline and unfamiliarity with computers were also perceived as important barriers. Conclusions This study offers a theoretical basis to understand physicians' beliefs towards completing an internet-based continuing medical education (CME) program on EBM. Based upon respondents' insights, several modifications were carried out to enhance the uptake of the program by physicians and, therefore, its implementation.

BackgroundDecision boxes (Dboxes) provide clinicians with research evidence about management options for medical questions that have no single best answer. Dboxes fulfil a need for rapid clinical training tools to prepare clinicians for clinician-patient communication and shared decision-making. We studied the barriers and facilitators to using the Dbox information in clinical practice.MethodsWe used a mixed methods study with sequential explanatory design. We recruited family physicians, residents, and nurses from six primary health-care clinics. Participants received eight Dboxes covering various questions by email (one per week). For each Dbox, they completed a web questionnaire to rate clinical relevance and cognitive impact and to assess the determinants of their intention to use what they learned from the Dbox to explain to their patients the advantages and disadvantages of the options, based on the theory of planned behaviour (TPB). Following the 8-week delivery period, we conducted focus groups with clinicians and interviews with clinic administrators to explore contextual factors influencing the use of the Dbox information.ResultsOne hundred clinicians completed the web surveys. In 54% of the 496 questionnaires completed, they reported that their practice would be improved after having read the Dboxes, and in 40%, they stated that they would use this information for their patients. Of those who would use the information for their patients, 89% expected it would benefit their patients, especially in that it would allow the patient to make a decision more in keeping with his/her personal circumstances, values, and preferences. They intended to use the Dboxes in practice (mean 5.6 ± 1.2, scale 1–7, with 7 being “high”), and their intention was significantly related to social norm, perceived behavioural control, and attitude according to the TPB (P < 0.0001). In focus groups, clinicians mentioned that co-interventions such as patient decision aids and training in shared decision-making would facilitate the use of the Dbox information. Some participants would have liked a clear “bottom line” statement for each Dbox and access to printed Dboxes in consultation rooms.ConclusionsDboxes are valued by clinicians. Tailoring of Dboxes to their needs would facilitate their implementation in practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0144-6) contains supplementary material, which is available to authorized users.

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