Assessing the impact of institution-specific guidelines for antimicrobials on doctors’ prescribing behavior at a German tertiary-care center and the additional benefits of providing a mobile application

Abstract

Objective To assess usage patterns, perceived usability, and effects of institution-specific guidelines (ISGs) for antimicrobials on clinicians’ prescribing behavior and the additional benefits of the mobile application (app), a single-center survey among medical doctors was performed. Methods The study was carried out in a 1451-bed tertiary-care academic medical center in Leipzig, Germany. To ensure optimal empirical antibiotic therapies, appropriate diagnostics, and targeted antimicrobial prophylaxis, ISGs were provided as printed pocket guides (since 2014), a PDF version on ward computers, and a mobile app (since 2017). For the survey, we used an electronically structured cross-sectional questionnaire with 31 items, ordinal Likert scales, and percent bars, allowing for quantitative comparisons. Results Of the 914 doctors contacted by email, 282 (31%) responded, and 254 (28%) surveys were eligible. ISGs were reported to be the most commonly used source of information for antimicrobial prescribing among the respondents. Ninety-four percent used ISGs at least once and 55% at least weekly. On average, participants reported using them in 38% of antibiotic prescriptions and to adhere to consulted recommendations in 87% of cases. Young clinicians (≤ 30 years) reported significantly higher use of the ISGs than their older colleagues (47% vs. 35% of antibiotic prescriptions, p = 0.004). Ninety-six percent of users found ISGs to be user-friendly, and nearly 100% recommended ISGs to other colleagues. Forty-five percent regarded the app as the most user-friendly way to access ISGs, and app users were significantly more likely to use ISGs regularly (p = 0.024). Eighty-four percent reported behavioral changes regarding at least one aspect of antimicrobial therapy (e.g. duration, application mode, prescription frequency), while 54% reported changes regarding the choice of specific substance groups. Conclusions ISGs are used regularly and appear to have a relevant impact on clinicians’ prescribing habits. A mobile app may be the most effective way to provide ISGs, although multiple platforms seem to add value. While the majority of participants reported perceived effects on their prescribing behavior, this study does not allow any conclusions to be drawn about the extent of the effects of ISGs on antibiotic use and patient outcomes.

Changes in antibiotic consumption, AMR and Clostridioides difficile infections in a large tertiary-care center following the implementation of institution-specific guidelines for antimicrobial therapy: A nine-year interrupted time series study

“…In many cases it is considered necessary that patients are discharged from the hospital as soon as oral administration of antibiotics is possible to avoid financial sanctions. Nevertheless, this finding suggests that the goal of sequential parenteral to oral therapy might not be sufficiently met, which would be in line with responses in a previous survey-based study where several respondents pointed out the need for recommendations for oral antimicrobial therapy [ 17 ].…”

“…The Leipzig University Hospital (LUH) is a 1,451-bed tertiary-care facility with 29 departments and clinics of all specialties in Leipzig, Germany. Since 2012, several interdisciplinary AMS interventions have been implemented, including regular ward visits by the AMS team, intense training of staff, restriction of selected reserve antibiotics, surveillance of antibiotic consumption and resistance and the implementation of professional ISGs, as described before [ 17 , 22 – 24 ].…”

“…Several studies showed that local guidelines can lead to behavioral changes among physicians, yet few investigated the influence on antimicrobial consumption and resistance [ 12 – 16 ]. The Leipzig University Hospital first introduced ISGs in 2014 as a printed pocket guide; an electronic application was added in 2017 [ 17 , 18 ]. In a previous, survey-based study we found that the ISGs were successfully implemented, regularly used across disciplines and had a perceived influence on physicians’ prescribing behavior [ 17 ].…”

“…The Leipzig University Hospital first introduced ISGs in 2014 as a printed pocket guide; an electronic application was added in 2017 [ 17 , 18 ]. In a previous, survey-based study we found that the ISGs were successfully implemented, regularly used across disciplines and had a perceived influence on physicians’ prescribing behavior [ 17 ].…”

Development of a mobile application for vancomycin dosing calculation: A useful tool for the rational use of antimicrobials

“…Ketcherside et al 19 assessed feasibility and acceptance of a cloud-based mobile app for antimicrobial stewardship and infection control. Schönherr et al 20 assessed the additional benefits of the mobile apps in the impact of institution-specific guidelines for antimicrobials on doctors' prescribing. In this study, the development of a mobile app to calculate vancomycin dosing contributes for the antimicrobial stewardship programs, since the optimization of dosage regimens is one of the strategies for these programs.…”