Summary of findings for the main comparison. Shared decision making compared to usual care for acute respiratory infections in primary care.
| Shared decision making compared to usual care for acute respiratory infections in primary care | ||||||
| Patient or population: antibiotic use in acute respiratory infections Setting: primary care Intervention: interventions to facilitate shared decision making Comparison: usual care | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with usual care | Risk with Interventions to facilitate shared decision making | |||||
| Antibiotics prescribed or dispensed (6 weeks or less) assessed with: risk ratio | Moderate | RR 0.61 (0.55 to 0.68) | 10172 (8 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | ||
| 47 per 100 | 29 per 100 (26 to 32) | |||||
| Antibiotics prescribed or dispensed (12 months or greater) assessed with: risk ratio | Moderate | RR 0.74 (0.49 to 1.11) | 481588 (3 RCTs) 3 | ⊕⊕⊝⊝ LOW 1 2 | ||
| 47 per 100 | 35 per 100 (23 to 52) | |||||
| Patient initiated re‐consultations for the same illness episode | Moderate | RR 0.87 (0.74 to 1.03) | 1861 (4 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | ||
| 40 per 100 | 35 per 100 (30 to 41) | |||||
| Patient satisfaction with the consultation | Moderate | OR 0.86 (0.57 to 1.30) | 1052 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 4 | ||
| 71 per 100 | 68 per 100 (58 to 76) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: Odds ratio; RCT: randomised controlled trial; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Downgraded one level because of risk of bias: participants in most studies were aware of whether they had received the intervention or not.
2 Downgraded one level because of imprecision: confidence interval includes reduction and possible increase in use of antibiotics. There was considerable heterogeneity in the rates of antibiotic prescribing during longer‐term follow‐up (12 months or greater).
3 Sample numbers in one trial, Butler 2012, were calculated from mean list size at baseline multiplied by the number of participating practices in each group (practice list sizes vary over time and no denominator data were available).
4 Downgraded one level due to imprecision: confidence interval includes both satisfaction and lack of satisfaction of patients with the consultation.