Antibiotic stewardship using ePOCT+, a digital health clinical decision support algorithm for paediatric outpatient care: results from the DYNAMIC Tanzania cluster randomized controlled trial

Tan, Rainer; Kavishe*, Godfrey; Kulinkina*, Alexandra; Luwanda*, Lameck; Renggli, Sabine; Mangu, Chacha; Ashery, Geofrey; Jorram, Margaret; Mtebene, Ibrahim; Agrea, Peter; Mhagama, Humphrey; Vonlanthen, Alan; Faivre, Vincent; Thabard, Julien; Levine, Gillian; Pogam, Marie-Annick Le; Keitel, Kristina; Taffé, Patrick; Ntinginya**, Nyanda; Masanja**, Honorati; D'Acremont**, Valérie

doi:10.21203/rs.3.rs-3084190/v1

Cited by 1 publication

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“…Within the parent trial, health facilities were randomized 1:1 by an independent statistician, stratified by monthly attendance, type of health facility (dispensary or health centre), region, and council [37]. For the present ancillary study, another independent statistician sampled 18/40 facilities to be included.…”

Section: Randomizationmentioning

confidence: 99%

Quality of care when using a digital clinical decision support algorithm to manage sick children at primary care health facilities in Tanzania: a cross-sectional cluster randomized controlled trial (DYNAMIC study)

Tan,

Kavishe,

Kulinkina

et al. 2024

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Digital clinical decision support tools have contributed to improved quality of care at primary care level health facilities. However, data from real-world randomized trials are lacking. We conducted a cluster randomized, open-label trial in Tanzania evaluating the use of a digital clinical decision support algorithm (CDSA), enhanced by point-of-care tests, training and mentorship, compared with usual care, among sick children 2 to 59 months old presenting to primary care facilities for an acute illness in Tanzania (ClinicalTrials.govNCT05144763). The primary outcome was the mean proportion of 14 major Integrated Management of Childhood Illness (IMCI) symptoms and signs assessed by clinicians. Secondary outcomes included antibiotic prescription, counselling provided, and the appropriateness of antimalarial and antibiotic prescriptions. A total of 450 consultations were observed in 9 intervention and 9 control health facilities. The mean proportion of major symptoms and signs assessed in intervention health facilities was 46.4% (range 7.7% to 91.7%) compared to 26.3% (range 0% to 66.7%) in control health facilities, an adjusted difference of 15.1% (95% confidence interval [CI] 4.8% to 25.4%). Only weight, height, and pallor were assessed more often when using the digital CDSA than in controls. Observed antibiotic prescription was 37.3% in intervention facilities, and 76.4% in control facilities (adjusted risk ratio 0.5; 95% CI 0.4 to 0.7; p<0.001). Appropriate antibiotic prescription was 81.9% in intervention facilities and 51.4% in control facilities (adjusted risk ratio 1.5; 95% CI 1.2 to 1.8; p=0.003). The implementation of a digital CDSA improved only slightly the mean proportion of IMCI symptoms and signs assessed in consultations with sick children, and most symptoms and signs were assessed infrequently. Nonetheless, antibiotics were prescribed less often, and more appropriately Innovative approaches to overcome barriers related to clinicians’ motivation and work environment are needed.

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Section: Randomizationmentioning

confidence: 99%