Please select the eligibility criteria that correspond to the clinical trial below.
Title: DECISION+: Une Formation Pour Les médecins de Famille Sur la Prise de décision partagée Afin d'Optimiser Les décisions Cliniques Concernant l'Utilisation d'Antibiotiques Pour Les Infections aiguës Des Voies Respiratoires (IAVR)
Brief Summary: Decisions about the use of antibiotics for acute respiratory infections are the most frequently reported reason for consulting a family physician. Although it varies according to the specific type of acute respiratory infections, the use of antibiotics is estimated to be 63% to 67%, well above the expected prevalence of bacterial infections thus suggesting overuse of antibiotics. Consequently, there is an urgent need for helping family physicians and their patients to improve the clinical decision making process regarding the use of antibiotics for acute respiratory infections. We will evaluate the impact of DECISION +, a multifaceted intervention program that includes training in shared decision making, reminders and feedback targeting physicians, and decision support tools targeting patients on the decision to use antibiotics for acute respiratory infections. Results from this study will lay the ground for a national strategy targeting the improvement of the clinical decision making process regarding antibiotic use for acute respiratory infections in primary care. In turn, this will increase quality of care and patient safety.


Options:
A: DISEASE CHARACTERISTICS:

* Overdue for colorectal cancer screening (identified using automated extracts from the electronic medical record), as defined by the following criteria:

  * No fecal occult blood test within the past 12 months
  * No flexible sigmoidoscopy within the past 5 years
  * No colonoscopy within the past 10 years
* Receiving primary care at a Harvard Vanguard Medical Associates (HVMA) center
* Registered to use the HVMA patient portal (MyHealth) AND has an active MyHealth account

PATIENT CHARACTERISTICS:

* Not specified

PRIOR CONCURRENT THERAPY:

* See Disease Characteristics
B: Inclusion Criteria:

* Primary care provider is participating in trial
* Are an adult (≥ 18 years) with type 2 diabetes
* English speaking
* Recognize their primary care provider as their main diabetes care provider
* Declare being available for follow-up for six months after treatment decision

Exclusion Criteria:

- Have major barriers to provide written informed consent and to participate in shared decision making (i.e., severe vision or hearing impairment, cognitive impairment, non-English speaking)

Additional Inclusion Criteria for Diabetes Medication:

* Have a clinical diagnosis of type 2 diabetes for one year or more (c-peptide test is not required)
* Use 0, 1, or 2 oral hypoglycemic agents at maximum doses
* Have stable but inadequate glycemic control or worsening glycemic control as identified by their most recent HbA1c measure (within 12 months of the time of eligibility over 7.3%
* Be identified by provider as a medically-appropriate candidate for diabetes medications, (i.e., have not contraindications to taking the medications, e.g., allergy).

Additional Exclusion Criteria for Diabetes Medication:

- Use insulin therapy.

Additional Inclusion Criteria for Cardiovascular Medication:

* Have a clinical diagnosis of type 2 diabetes for any duration (c-peptide test is not required).
* Be identified by provider as a medically-appropriate candidate for statins, (i.e., have not contraindications to taking the medications, e.g., allergy).

Additional Exclusion Criteria for Cardiovascular Medication:

- Use a statin currently.
C: FAMILY PHYSICIANS:

Inclusion Criteria:

* All FP (teachers and residents) providing care in the walk-in clinic in each Family Practice Teaching Unit (FPTU) will be eligible to participate in the trial.

Exclusion Criteria:

* he/she was involved or participated in the DECISION + pilot RCT
* he/she is not expected to be practicing at the FPTU for the whole duration of the study (e.g. residents ending their residency program or doing rotations outside of the FPTU, planned pregnancy/delivery, planned retirement).

PATIENTS:

Inclusion Criteria:

* if 17 years old and under, must be accompanied by a parents or a guardians)
* they are consulting a participating physician for an ARI, for which treatment with an antibiotic is considered
* they are able (patients or the accompanying parent or guardians) to read, understand and write French (expected level: 8th grade)
* they give informed consent

Exclusion Criteria:

* Patients with a condition requiring emergency care will be excluded.
D: Inclusion Criteria:

* Referred for consideration of an ICD(non-CRT)for a primary prevention indication
* English speaking
* able to provide informed consent

Exclusion Criteria:

* unable to understand the decision aid due to a language barrier or visual impairment
* referred for secondary prevention indication

Answer: C