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Abstract
ObjectiveTo 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.MethodsThe 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.ResultsOf 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.ConclusionsISGs 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.
Highlights
Institution-specific guidelines (ISGs) for antimicrobial agents are considered an important part of antibiotic stewardship (ABS) programs [1,2]
Young clinicians ( 30 years) reported significantly higher use of the ISGs than their older colleagues (47% vs. 35% of antibiotic prescriptions, p = 0.004)
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
Summary
Institution-specific guidelines (ISGs) for antimicrobial agents are considered an important part of antibiotic stewardship (ABS) programs [1,2]. To assess patterns of use, perceived usability, and effects of ISGs on clinicians’ prescribing behavior, as well as the additional benefits of the app, a survey was carried out among medical doctors to document the following information: (i) clinicians’ attitudes and behavior toward recommendations of ISGs, (ii) the impact of ISGs on the usage of antimicrobials by clinicians, (iii) the potential added value of the app version of the ISGs, and (iv) differences in ISG use between subgroups defined by medical specialization, age, sex, and exposure to regular ward rounds by an ABS team—which is composed of a clinical microbiologist, an infectious disease expert, and a clinical pharmacist. Regular ABS rounds are carried out in the following medical areas: neonatology, pediatric intensive care unit (ICU), surgical isolation ward, transplant surgery, gastroenterology/hepatology, pneumology, surgical ICU, medical ICU, and neurological ICU
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