You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial
Abstract 1:
Background : Few interventions have proven effective in reducing the overuse of antibiotics for acute respiratory infections . We evaluated the effect of DECISION+2 , a shared decision-making training program , on the percentage of patients who decided to take  antibiotics  after consultation with a physician or resident . Methods : We performed a r and omized trial , clustered at the level of family practice teaching unit , with 2 study arms : DECISION+2 and control . The DECISION+2 training program included a 2-hour online tutorial followed by a 2-hour interactive seminar about shared decision-making . The primary outcome was the proportion of patients who decided to use antibiotics immediately after consultation . We also recorded patients ’ perception that shared decision-making had occurred . Two weeks after the initial consultation , we assessed patients ’ adherence to the decision , repeat consultation , decisional regret and quality of life . Results : We compared outcomes among 181 patients who consulted 77 physicians in 5 family practice teaching units in the DECISION+2 group , and 178 patients who consulted 72 physicians in 4 family practice teaching units in the control group . The percentage of patients who decided to use antibiotics after consultation was 52.2 % in the control group and 27.2 % in the DECISION+2 group ( absolute difference 25.0 % , adjusted relative risk 0.48 , 95 % confidence interval 0.34–0.68 ) . DECISION+2 was associated with patients taking a more active role in decision-making ( Z = 3.9 , p < 0.001 ) . Patient outcomes 2 weeks after consultation were similar in both groups . Interpretation : The shared decision-making program DECISION+2 enhanced patient participation in decision-making and led to fewer patients deciding to use antibiotics for acute respiratory infections . This reduction did not have a negative effect on patient outcomes 2 weeks after consultation . Clinical Trials.gov trial register no. NCT01116076


Title 2:
Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention study.
Abstract 2:
OBJECTIVES Assessing the efficacy of an educational intervention that aim ed to reduce unnecessary antibiotic prescriptions in primary care by motivating GPs to change their attitudes to communication and by empowering patients . METHODS One hundred and four GPs in North-Rhine/Westphalia-Lippe , Germany were cluster-r and omized into intervention and control . GPs r and omized to receive the intervention were visited by peers . The intervention strategy was focused on the communication within the encounter , not on sharing knowledge about antibiotic prescribing . Leaflets and posters were provided that aim ed at patient empowerment , thus enabling patients to raise the topic of antibiotic prescriptions themselves . RESULTS Eighty-six GPs ( 83 % ) remained in the study at 6 weeks and 61 GPs ( 59 % ) at 12 months . Antibiotic prescription rates within the control group were 54.7 % at baseline and 36.4 % within the intervention group at baseline . Generalized estimating equation models were applied . Baseline imbalances and confounding variables were controlled by adjustment . After the intervention , the ORs for the prescription of an antibiotic dropped to 0.58 [ 95 % CI : ( 0.43;0.78 ) , P < 0.001 ] after 6 weeks and were 0.72 [ 95 % CI : ( 0.54;0.97 ) , P = 0.028 ] after 12 months in the intervention group . In the control group , the ORs rose to 1.52 [ 95 % CI : ( 1.19;1.95 ) , P = 0.001 ] after 6 weeks and were 1.31 [ 95 % CI : ( 1.01;1.71 ) , P = 0.044 ] after 12 months ; these ORs correspond to an approximately 60 % relative reduction in antibiotic prescription rates at 6 weeks and a persistent 40 % relative reduction at 12 months . CONCLUSIONS An interventional strategy that focused on doctor-patient communication and patient empowerment is an effective concept to reduce antibiotic prescriptions in primary care


Title 3:
Communication training and antibiotic use in acute respiratory tract infections. A cluster randomised controlled trial in general practice.
Abstract 3:
UNLABELLED A cluster-r and omised controlled trial in general practice BACKGROUND Physician-patient communication plays a key role in treatment decisions in primary care . We aim ed to reduce the antibiotic prescription rate for acute respiratory tract infections using a short training programme in patient-centred communication . METHODS We conducted a cluster-r and omised controlled trial in 45 general practice s in Switzerl and . Thirty physicians received evidence -based guidelines for the management of acute respiratory tract infections ; 15 physicians r and omised to the full intervention additionally received training in patient-centred communication .  A further 15 physicians , not r and omised , served as a control to blind the physicians in the other two groups to the true comparison . The primary outcome was the antibiotic prescription rate reported by pharmacists . Secondary outcomes were patient satisfaction and enablement , re-consultation rates , days with restrictions , and days off work .  1108 adults with acute respiratory infections were screened between January and May 2004 . Outcomes were measured in 837 consultations ; 624 patients had follow-up interviews at 7 and 14 days . RESULTS The antibiotic prescription rate reported by pharmacists was low in both full and limited intervention groups ( 13.5 % and 15.7 % respectively ) but only half of the antibiotics were prescribed according to guidelines ( 53.8 % and 53.1 % ) . No significant differences were seen between the two r and omised groups in primary and secondary outcomes . In both groups patient satisfaction was high ( median score for both 68 out of 70 ) . CONCLUSIONS In this trial , patient-centred communication training did not reduce the rate of antibiotic prescriptions below an already unusually low level . Even with this low prescription rate , patient satisfaction with received care was high
Results : College students and younger , more educated , adults prefer shared decision making .
Shared decision making shows promise for decreasing antibiotic use for respiratory tract infections .