Attitudes and Behaviours to Antimicrobial Prescribing following Introduction of a Smartphone App

Abstract

ObjectivesOur hospital replaced the format for delivering portable antimicrobial prescribing guidance from a paper-based pocket guide to a smartphone application (app). We used this opportunity to assess the relationship between its use and the attitudes and behaviours of antimicrobial prescribers.MethodsWe used 2 structured cross-sectional questionnaires issued just prior to and 3 months following the launch of the smartphone app. Ordinal Likert scale responses to both frequencies of use and agreement statements permitted quantitative assessment of the relationship between variables.ResultsThe smartphone app was used more frequently than the pocket guide it replaced (p < 0.01), and its increased use was associated with sentiments that the app was useful, easy to navigate and its content relevant. Users who used the app more frequently were more likely to agree that the app encouraged them to challenge inappropriate prescribing by their colleagues (p = 0.001) and were more aware of the importance of antimicrobial stewardship (p = 0.005). Reduced use of the app was associated with agreement that senior physicians’ preferences for antimicrobial prescribing would irrespectively overrule guideline recommendations (p = 0.0002).ConclusionsSmartphone apps are an effective and acceptable format to deliver guidance on antimicrobial prescribing. Our findings suggest that they may empower users to challenge incorrect prescribing, breaking well-established behaviours, and thus supporting vital stewardship efforts in an era of increased antimicrobial resistance. Future work will need to focus on the direct impact on drug prescriptions as well as identifying barriers to implementing smartphone apps in other clinical settings.

Effect of adding a mobile health intervention to a multimodal antimicrobial stewardship programme across three teaching hospitals: an interrupted time series study

“…The mechanisms to measure and describe the utility of such mHealth interventions should be multimodal, and sensitive enough to measure the added value in the context of multiple interventions aimed at maximizing outcome measures. We would advocate integrating quantitative measures such as those presented here with qualitative criteria such as increased access to the policy at the point of care, the reach of the policy to healthcare professionals and the feedback from users 15 , 21 . In this study, the addition of the antimicrobial prescribing policy as an mHealth app to a multifaceted ASP did not demonstrate a significant change in antimicrobial prescribing trends.…”

Improving Access to Antimicrobial Prescribing Guidelines in 4 African Countries: Development and Pilot Implementation of an App and Cross-Sectional Assessment of Attitudes and Behaviour Survey of Healthcare Workers and Patients

“…Both studies show that the health professionals found apps useful and relevant to their patient population. They also agreed that apps encouraged them to challenge inappropriate prescribing [ 6 ]. The concern displayed by healthcare workers for the emergence of drug-resistant infections and the use of the standard treatment guidelines as seen in Table 6 was highly impressive.…”

“…There has been a recent rise in the use of smartphones generally across global population and it is predicted to be rising fastest in Africa. There has been increased development of smartphone apps designed for use in healthcare, including in the area of antimicrobial stewardship [ 3 , 4 , 5 , 6 , 7 ]. Current research in medicine has shown that the use of mobile phones and devices in medical settings is more popular and is increasingly being brought to the fore of international research [ 1 ].…”

Time Efficiency Assessment of Antimicrobial Stewardship Strategies

“…PPRF can take many forms but is invariably both human resource and time intensive. Many hospitals may lack the resources to initiate this level of stewardship universally [3,4], and there is therefore a need to identify the form of PPRF that most efficiently impacts inappropriate antimicrobial prescribing [5,6]. We performed a prospective, observational study that compared different forms of PPRF: ward round reviews on acute medical wards, ward round reviews on surgical recovery wards, and telephone reviews with clinical teams caring for patients receiving carbapenems, cephalosporines, or quinolones.…”