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

Abstract

Objectives: To evaluate the impact of adding a mobile health (mHealth) decision support system for antibiotic prescribing to an established antimicrobial stewardship programme (ASP). Methods: In August 2011, the antimicrobial prescribing policy was converted into a mobile application (app). A segmented regression analysis of interrupted time series was used to assess the impact of the app on prescribing indicators, using data (2008–14) from a biannual point prevalence survey of medical and surgical wards. There were six data points pre-implementation and six data points post-implementation. Results: There was an increase in compliance with policy (e.g. compliance with empirical therapy or expert advice) in the two specialties of medicine (6.48%, 95% CI = −1.25 to 14.20) and surgery (6.63%, 95% CI = 0.15–13.10) in the implementation period, with a significant sudden change in level in surgery (P < 0.05). There was an increase, though not significant, in medicine (15.20%, 95% CI = −17.81 to 48.22) and surgery (35.97%, 95% CI = −3.72 to 75.66) in the percentage of prescriptions that had a stop/review date documented. The documentation of indication decreased in both medicine (−16.25%, 95% CI = −42.52 to 10.01) and surgery (−14.62%, 95% CI = −42.88 to 13.63). Conclusions: Introducing the app into an existing ASP had a significant impact on the compliance with policy in surgery, and a positive, but not significant, effect on documentation of stop/review date in both specialties. The negative effect on the third indicator may reflect a high level of compliance pre-intervention, due to existing ASP efforts. The broader value of providing an antimicrobial policy on a digital platform, e.g. the reach and access to the policy, should be measured using indicators more sensitive to mHealth interventions.

Understanding antibiotic decision making in surgery—a qualitative analysis

“…The hospitals operate across a 1300bed multisite healthcare organization. The same organizational structure and antibiotic stewardship programme, including specialist pharmacists, bespoke guidelines and microbiology services, are implemented across all the hospitals [26].…”

Use of stewardship smartphone applications by physicians and prescribing of antimicrobials in hospitals: A systematic review

“…No change in documentation of stop/review dates was reported during or after the intervention period. Remarkably, documentation on the reason to start antimicrobials decreased significantly during intervention and this sustained during follow up measurements over the next two years [37]. 19% to 27%, p = 0.04; Hospital 2: 9% to 9%, p = 0.98 UTI: Hospital 1: 47% to 50%, p = 0.49; Hospital 2: 45% to 40%, p = 0.28; Hospital 3: 24% to 29%, p = 0.25…”

“…Four studies analysed whether empirical prescribing of antimicrobials was according to guidelines, such as choice of drug, dose, interval and route of administration [25,31,34,37]. (Table 4) The study of Charani et al in which all antimicrobial guidelines were implemented in the app reported a significant increase in adherence to guidelines in surgical wards and a non-significant increase in general medicine wards [37]. This increase persisted after six and…”

“…Also, no change in adherence to the UTI guideline was shown in any of the three participating hospitals. Documentation of stop/review dates and indication for starting antimicrobials in the medical charts was evaluated in one study [37]. No change in documentation of stop/review dates was reported during or after the intervention period.…”

“…To evaluate appropriate prescribing of antimicrobials, different outcome parameters were selected: choice of antimicrobials, dose, dosing interval and route of administration. One study also included indication and stop/ review date documentation [37]. This variation in outcome parameters reflects the difficulty in defining appropriate antimicrobial prescribing.…”