Evidencing general acceptability of open-label placebo use for tackling overtreatment in primary care: a mixed methods study.
Analgesics
Antibiotics
Antidepressants
Antimicrobial resistance
Antimicrobial stewardship
Open-label placebos
Overprescribing
Overtreatment
Placebos
Primary care
Journal
BMC medicine
ISSN: 1741-7015
Titre abrégé: BMC Med
Pays: England
ID NLM: 101190723
Informations de publication
Date de publication:
19 09 2023
19 09 2023
Historique:
received:
17
04
2023
accepted:
07
09
2023
medline:
21
9
2023
pubmed:
20
9
2023
entrez:
19
9
2023
Statut:
epublish
Résumé
Overtreatment poses a challenge to healthcare systems due to harmful consequences of avoidable side-effects and costs. This study presents the first account for examining the feasibility of placebo use for reducing overtreatment in primary care, including whether public attitudes support the use of different placebo types in place of inappropriate prescriptions of antibiotics, antidepressants, or analgesics. We used a multi-study, mixed-methods design, including patient and public (PPI) consultations, focus groups (Study 1) and two pre-registered online experiments (Studies 2 and 3). Study 1 (N = 16) explored everyday conceptions and practicalities of potential placebo use in the context of respiratory infections. Findings highlighted the importance of trusting doctor-patient relationships and safety-netting. Study 2 employed a randomised experiment with a representative UK sample (N = 980), investigating attitudes towards 5 different treatment options for respiratory infections: (1) blinded + pure placebo, (2) open-label + pure placebo, (3) open-label + impure placebo, (4) antibiotic treatment, and (5) no treatment. Study 2 also examined how attitudes varied based on wording and individual differences. Findings indicated general support (η Findings from PPI and three studies indicate general support for combatting overprescribing in primary care through clinical placebo use. This is an indicator for wider UK public support for a novel, behavioural strategy to target a long-standing healthcare challenge. General acceptability appears to be highest for the use of open-label + impure placebos in the context of antibiotic overprescribing.
Sections du résumé
BACKGROUND
Overtreatment poses a challenge to healthcare systems due to harmful consequences of avoidable side-effects and costs. This study presents the first account for examining the feasibility of placebo use for reducing overtreatment in primary care, including whether public attitudes support the use of different placebo types in place of inappropriate prescriptions of antibiotics, antidepressants, or analgesics.
METHODS
We used a multi-study, mixed-methods design, including patient and public (PPI) consultations, focus groups (Study 1) and two pre-registered online experiments (Studies 2 and 3).
RESULTS
Study 1 (N = 16) explored everyday conceptions and practicalities of potential placebo use in the context of respiratory infections. Findings highlighted the importance of trusting doctor-patient relationships and safety-netting. Study 2 employed a randomised experiment with a representative UK sample (N = 980), investigating attitudes towards 5 different treatment options for respiratory infections: (1) blinded + pure placebo, (2) open-label + pure placebo, (3) open-label + impure placebo, (4) antibiotic treatment, and (5) no treatment. Study 2 also examined how attitudes varied based on wording and individual differences. Findings indicated general support (η
CONCLUSIONS
Findings from PPI and three studies indicate general support for combatting overprescribing in primary care through clinical placebo use. This is an indicator for wider UK public support for a novel, behavioural strategy to target a long-standing healthcare challenge. General acceptability appears to be highest for the use of open-label + impure placebos in the context of antibiotic overprescribing.
Identifiants
pubmed: 37726759
doi: 10.1186/s12916-023-03074-4
pii: 10.1186/s12916-023-03074-4
pmc: PMC10510165
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Randomized Controlled Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
362Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 204801/Z/16/Z
Pays : United Kingdom
Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Br J Gen Pract. 2011 Feb;61(583):101-7
pubmed: 21276337
Pain. 2019 Jan;160(1):1-4
pubmed: 30086114
Med Decis Making. 2020 Jan;40(1):72-80
pubmed: 31975657
Annu Rev Psychol. 2011;62:391-417
pubmed: 20809791
J Exp Psychol Appl. 2020 Sep;26(3):422-431
pubmed: 32271052
J Adv Nurs. 2001 Mar;33(5):668-76
pubmed: 11298204
PLoS One. 2014 Jul 09;9(7):e101822
pubmed: 25006673
BMJ Clin Evid. 2011 Mar 16;2011:
pubmed: 21406124
J Dev Behav Pediatr. 2010 Jun;31(5):369-75
pubmed: 20495473
J Am Board Fam Med. 2009 Jan-Feb;22(1):62-8
pubmed: 19124635
BMJ Qual Saf. 2022 Jun 15;:
pubmed: 35705434
BMJ Qual Saf. 2022 Mar;31(3):163-167
pubmed: 34285113
Nurse Res. 2006 Jul 1;13(4):84
pubmed: 27702218
BMJ Qual Saf. 2018 Jul;27(7):571-575
pubmed: 29572297
BMC Psychol. 2022 Feb 4;10(1):20
pubmed: 35120572
Soc Sci Med. 1993 Mar;36(6):767-74
pubmed: 8480221
Spine (Phila Pa 1976). 2006 Apr 20;31(9):998-1006
pubmed: 16641776
J Fam Pract. 2017 Dec;66(12):730-736
pubmed: 29202142
Qual Health Res. 2005 Nov;15(9):1277-88
pubmed: 16204405
J Pers Soc Psychol. 2012 May;102(5):980-93
pubmed: 22429272
JAC Antimicrob Resist. 2020 Sep;2(3):dlaa067
pubmed: 34192252
Br J Health Psychol. 2023 May;28(2):273-290
pubmed: 36086862
PLoS One. 2010 Dec 22;5(12):e15591
pubmed: 21203519
Swiss Med Wkly. 2014 Feb 13;144:w13899
pubmed: 24526325
BMC Fam Pract. 2011 Mar 24;12:11
pubmed: 21435197
Ann Intern Med. 2011 Jul 19;155(2):97-107
pubmed: 21768583
N Z Med J. 2009 Jun 05;122(1296):35-46
pubmed: 19652679
J Gen Intern Med. 2015 Aug;30 Suppl 3:S586-94
pubmed: 26105672
Arch Gen Psychiatry. 1965 Apr;12:36-45
pubmed: 14258363
BMC Med. 2010 Feb 23;8:15
pubmed: 20178561
Patient Educ Couns. 2013 Feb;90(2):247-53
pubmed: 23206659
Lancet. 2010 Feb 20;375(9715):686-95
pubmed: 20171404
Image J Nurs Sch. 1994 Winter;26(4):272-6
pubmed: 7829111
Sci Rep. 2021 Feb 16;11(1):3855
pubmed: 33594150
Child Care Health Dev. 2008 Jan;34(1):104-10
pubmed: 18171451
N Engl J Med. 2015 Jul 2;373(1):8-9
pubmed: 26132938
PLoS One. 2013;8(3):e58247
pubmed: 23526969
Nature. 2017 May 3;545(7652):23-25
pubmed: 28470219
J Family Med Prim Care. 2020 Aug 25;9(8):3815-3819
pubmed: 33110773
J Exp Psychol Appl. 2019 Jun;25(2):149-161
pubmed: 30024212
Theor Med Bioeth. 2015 Aug;36(4):279-89
pubmed: 26215744
J Pharm Policy Pract. 2022 Nov 8;15(1):79
pubmed: 36348416
Sociol Health Illn. 2020 Aug;42 Suppl 1:1-20
pubmed: 32757281
BMC Public Health. 2012 Jan 25;12:80
pubmed: 22276600
J Psychosom Res. 2020 Jan;128:109866
pubmed: 31760341
Science. 1981 Jan 30;211(4481):453-8
pubmed: 7455683
Br J Gen Pract. 2014 Nov;64(628):e709-18
pubmed: 25348995