Briel 2006.

Methods	Randomization procedure: 30 GPs receiving guidelines for the management of acute respiratory tract infections were randomized to receive or not receive training in patient‐centered communication. A further 15 GPs (Group 3), who were not randomized and did not receive the guidelines for acute respiratory tract infections, served as control group. Informed consent obtained: Yes Protection against contamination: It is not stated in the article whether protection against contamination was performed. However, only one physician per practice was allowed to enter the study. Outcomes assessors blinded: trained medical students, blinded to the goal of the trial, conducted follow‐up interviews from the patients by phone. Intention to treat analysis: Stated as done Potential for unit of analysis error: was Present and it was acknowledged by reporting an estimated ICC. Comments on study quality: None
Participants	Profession: Medicine Specialty: General medicine, Internal medicine Years experience: years of postgraduate training, median: 9.2; years in private practice, median:14.3 Clinical setting: GPs from two cantons (Basel‐Stadt and Aargau) Level of Care: Primary Country: Switzerland Health problem/Type of Patient: Patients who were visiting as a first consultation for common cold, rhinosinusitis, pharyngitis, exudative tonsillitis, laryngitis, otitis media, bronchitis, exacerbated COPD or influenza.
Interventions	Aim of study (hypothesis): to determine whether training physicians in patient‐centered communication would reduce antibiotic prescription rate. Patient outcomes such as days with restricted activities, days off work, re‐consultation rates, patients' satisfaction with received care and their feelings of enablement were additionally investigated. Content of intervention: Guidelines for management of acute respiratory infection: Up‐dated guidelines, adopted to local conditions and reviewed by local experts, were developed by three authors based on existing US‐guidelines for the treatment of acute respiratory infections. Patient‐centered intervention: Physicians attended a six‐hour patient‐centered communication seminar in small groups and received two hours of personal feedback by phone. Conceptual Focus: 1‐ teaching physicians how to understand and modify patients' concepts and beliefs about the use of antibiotics for acute respiratory tract infections. 2‐ teaching physicians to practice elements of active listening, to respond to emotional clues, and to tailor information given to patients. 3‐ introducing physicians to a model by Prochaska, and DiClemente for identifying patients' attitudes and readiness for behavior changes. Number of providers receiving intervention: n = 15/45 (patient centered intervention + condition specific material (Full intervention) ); n= 15/45 (condition specific material (limited intervention)) Number of patient receiving intervention:  In full intervention group, 259 patients recruited, 253 patients interviewed at 7 days, 245 patients interview at 14 days. In limited intervention group, 293 patients recruited, 290 patients interviewed at 7 days, 287 patients interview at 14 days. Fidelity/integrity of intervention: Up‐dated guidelines for the management of acute respiratory tract infection were developed by authors and was distributed as a booklet and presented in an interactive two‐hour seminars. Physicians who received the patient‐centered intervention, also attended a six‐hour patient‐centered communication seminar in small groups and received two hours of personal feedback by phone.
Outcomes	Primary Outcomes: Prescribed antibiotics reported by pharmacists Consultation process: NA Satisfaction: Satisfaction with care received (Langewitz satisfaction survey relative to validation studies) Health behaviours: Re‐consultation within 14 days Health status: patient enablement, number of days with restricted activities
Notes	No significant results Meta‐Analysis: Health Status, Continuous: number of days with restricted activities Health Behaviors, Dichotomous: reconsultation within 14 days Satisfaction, Dichotomous: satisfaction with care (Langewitz score relative to validation survey) Prescribed antibiotics reported by pharmacists Unadjusted sample sizes: Full intervention: 259/15 (patients/physicians); Limited intervention: 287/15 (patients/physicians) ICC: .097 DEFF: 2.9 Given in article Adjusted sample sizes: Full intervention: n=259/2.9=  89 Limited intervention: n=293/2.9= 101
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	The "full intervention" and "limited intervention" groups were recruited randomly. The control group was not randomized.
Allocation concealment (selection bias)	Low risk	Allocation to either intervention was concealed using a computer generated list created by an independent institution.
Blinding (performance bias and detection bias) All outcomes	Low risk	The medical student who were interviewing the patients were blinded to the goal of study.
Incomplete outcome data (attrition bias) All outcomes	Low risk	They have reported the lost to follow‐up and used intention to treat analysis.
Selective reporting (reporting bias)	Low risk	All investigated outcomes were reported.
Other bias	Unclear risk	It is not stated if protection against contamination was made. However, only one physician per practice was recruited. There was potential for unit of analysis error which was acknowledged by using an estimated ICC.