title: Barriers and facilitators to the dissemination of DECISION+, a continuing medical education program for optimizing decisions about antibiotics for acute respiratory infections in primary care: a study protocol.
abstract: BACKGROUND
  In North America, acute respiratory infections are the main reason for doctors' visits in primary care. Family physicians and their patients overuse antibiotics for treating acute respiratory infections. In a pilot clustered randomized trial, we showed that DECISION+, a continuing medical education program in shared decision making, has the potential to reduce the overuse of antibiotics for treating acute respiratory infections. DECISION+ learning activities consisted of three interactive sessions of three hours each, reminders at the point of care, and feedback to doctors on their agreement with patients about comfort with the decision whether to use antibiotics. The objective of this study is to identify the barriers and facilitators to physicians' participation in DECISION+ with the goal of disseminating DECISION+ on a larger scale.
  
  
  METHODS
  This descriptive study will use mixed methods and retrospective and prospective components. All analyses will be based on an adapted version of the Ottawa Model of Research Use. First, we will use qualitative methods to analyze the following retrospective data from the pilot study: the logbooks of eight research assistants, the transcriptions of 15 training sessions, and 27 participant evaluations of the DECISION+ training sessions. Second, we will collect prospective data in semi-structured focus groups composed of family physicians to identify barriers and facilitators to the dissemination of a future training program similar to DECISION+. All 39 family physicians exposed to DECISION+ during the pilot project will be eligible to participate. We will use a self-administered questionnaire based on Azjen's Theory of Planned Behaviour to assess participants' intention to take part in future training programs similar to DECISION+.
  
  
  CONCLUSIONS
  Barriers and facilitators identified in this project will guide modifications to DECISION+, a continuing medical education program in shared decision making regarding the use of antibiotics in acute respiratory infections, to facilitate its dissemination in primary care on a large scale. Our results should help continuing medical educators develop a continuing medical education program in shared decision making for other clinically relevant topics. This will help optimize clinical decisions in primary care.
authors.affiliation: Research Center of Centre Hospitalier Universitaire de Québec, Hospital St-François D'Assise, Knowledge Transfer an Health Technology Assessment Research Group, 10 rue de l'Espinay, Québec, QC, G1L 3L5, Canada. France.Legare@mfa.ulaval.ca
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Allaire
authors.forename: Michel
authors.initials: M
authors.lastname: Labrecque
authors.forename: Anik
authors.initials: A
authors.lastname: Giguère
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Gagnon
authors.forename: Jeremy
authors.initials: J
authors.lastname: Grimshaw
authors.forename: France
authors.initials: F
authors.lastname: Légaré
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003657:Decision Making; D004059:Diffusion of Innovation; D004502:Education, Medical, Continuing / Q000379:methods* / Q000458:organization & administration; D017144:Focus Groups; D006801:Humans; D033181:Information Dissemination; D010358:Patient Participation / Q000379:methods; D010865:Pilot Projects; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents