Choice Behavior Clinical Trial
Official title:
DÉCISION+, a Continuous Professional Development Program to Improve Optimal Drug Prescription : a Feasibility Study
The objective of this project is to evaluate the feasibility of a larger randomized trial of the efficacy of DECISION+, a continuous professional development program integrating multiple components, to promote shared decision making concerning drug prescription.
The Conseil du médicament du Québec defines optimal drug use as a "use that maximizes
benefits and minimizes risks to population health by taking into account available options,
costs and resources as well as patient values and social values". This definition
appropriately recognizes the uncertainty surrounding the use of most drugs, i.e. there is
often more than one good therapeutic option. The Ottawa Decision Support Framework (ODSF)
guides practitioners in assessing decision-making needs in clinical practice, providing
support for client decision making, and evaluating the effectiveness of their interventions.
DECISION+ is an innovative continuous professional development program for physicians, based
on the principles of ODSF and Evidence-Based Medicine. It integrates multiple educational -
behavioral change components that aim at promoting optimal shared decision making with
respect to drug prescription. The investigators hypothesize that optimal shared decision
making should result in optimized prescription behaviors by the physician and optimized drug
use by the patient. The objective of this pilot clinical randomized trial of DECISION+ is to
evaluate the feasibility of a larger randomized clinical trial, in order to determine the
efficacy of the program to promote optimal shared decision making in regards to drug
prescription by physicians. This pilot evaluation of the program will focus on one clinical
theme: antibiotic prescription for acute respiratory infections (ARI).
The program targets general practitioners and combines three strategies that were proven
effective to improve healthcare practices:
1. Interactive workshops
2. Reminders of expected behaviors
3. Feedbacks
Three 180-minute workshops will be held over a six-month period and will include:
1. Retrieval and critical appraisal of information
2. Clinical practice guidelines
3. Acquisition of diagnostic skills
4. Communication of risks and benefits
5. Shared decision making skills
6. Barriers and facilitating factors to optimal shared decision making with respect to
drug prescription
Family physicians from four large group practices -the randomization unit- in the province
of Québec, Canada will be randomly selected and assigned to one of the following
interventions:
1. Immediate DECISION+ antibiotics/ARI program
2. 6-month delayed DECISION+ antibiotics/ARI program
The main outcome measure of this pilot trial is to determine the feasibility of implementing
the DECISION+ program on a large scale. Feasibility will be based on the proportion of
contacted group practices that agree to participate, the proportion of recruited physicians
that participate in the workshops, the level of satisfaction about the workshop, and the
proportion of missing data in each survey. Secondary outcomes will include measure of
decision to use antibiotics, decisional conflict, decisional regret, prescription profile of
antibiotics in ARI, script concordance test, physician' reaction to uncertainty and
intention to engage in SDM and to use clinical practice guidelines regarding the use of
antibiotics in ARI in future clinical encounters..
The investigators hypothesize that shared decision making will translate into an optimized
prescription by the physician and will lead to an optimized drug use by the patient. We
believe that this project will help to enhance the health of the Quebec citizen by a better
drug use by the patient.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Completed |
NCT02385838 -
Impact of Nutrition Labels on Consumer Purchasing Intentions
|
N/A | |
| Completed |
NCT00325923 -
Impact of a Decision Aid Regarding Natural Health Products for Menopausal Symptoms
|
N/A |