H.GUO1, A.CHOW1, H.GUO1, Z.HILDON2, A.CHOW3
Tan Tock Seng Hospital1, National University of Singapore2, Nanyang Technological University3
Overprescribing of antibiotics is a major driver of antimicrobial resistance (AMR). Shared decision-making (SDM) between patients and doctors can reduce unnecessary demands for antibiotics and therefore inappropriate antibiotic prescribing in primary care. Understanding the determinants of SDM would enable the design of targeted interventions to promote SDM to reduce inappropriate antibiotic prescribing in Singapore.
We conducted a nationally-representative cross-sectional population survey between November 2020 and January 2021 on a proportional stratified random sample of adult Singapore residents. Preference for SDM was defined as agreement to the statement “I would want my doctor to discuss with me and make the decision on antibiotic prescribing with me”. Trust in doctors was defined as the latent factor derived from principal component analysis of 7 questions from a validated scale by Hall et al 2002 (Cronbach’s alpha = 0.8960). A multivariable logistic regression model was constructed to assess for factors associated with preference for SDM.
A total of 2004 members of the public participated in the study. After adjusting for age, gender, ethnicity, education level, presence of chronic illnesses, knowledge on antibiotics use and knowledge on AMR, respondents who had trust in doctors (aOR 1.20, 95% CI 1.06-1.37, P=0.005) were 20% more likely to prefer being involved in SDM on antibiotics prescribed for them.
Creating opportunities to build trusting relationships between patients and doctors, such as continuity of care by the same primary care provider, can promote SDM on appropriate antibiotic prescribing.