Impact of a smartphone app on prescriber adherence to antibiotic guidelines in adult patients with community acquired pneumonia or urinary tract infections.

Chang Ho Yoon,Stephen Mcbride,Gayl Humphrey,Stephen R Ritchie,Kerry Read,Mark G Thomas,Rachel Chen,Eamon J Duffy,Mehreen Arshad

doi:10.1371/journal.pone.0211157

Chang Ho Yoon, Stephen Mcbride + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0211157

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Abstract

BackgroundMobile phone apps have been shown to enhance guideline adherence by prescribers, but have not been widely evaluated for their impact on guideline adherence by prescribers caring for inpatients with infections.ObjectivesTo determine whether providing the Auckland City Hospital (ACH) antibiotic guidelines in a mobile phone app increased guideline adherence by prescribers caring for inpatients with community acquired pneumonia (CAP) or urinary tract infections (UTIs).MethodsWe audited antibiotic prescribing during the first 24 hours after hospital admission in adults admitted during a baseline and an intervention period to determine whether provision of the app increased the level of guideline adherence. To control for changes in prescriber adherence arising from other factors, we performed similar audits of adherence to antibiotic guidelines in two adjacent hospitals.ResultsThe app was downloaded by 145 healthcare workers and accessed a total of 3985 times during the three month intervention period. There was an increase in adherence to the ACH antibiotic guidelines by prescribers caring for patients with CAP from 19% (37/199) to 27% (64/237) in the intervention period (p = 0.04); but no change in guideline adherence at an adjacent hospital. There was no change in adherence to the antibiotic guidelines by prescribers caring for patients with UTI at ACH or at the two adjacent hospitals.ConclusionsProvision of antibiotic guidelines in a mobile phone app can significantly increase guideline adherence by prescribers. However, providing an app which allows easy access to antibiotic guidelines is not sufficient to achieve high levels of prescriber adherence.

Highlights

In response to the growing threat of antibiotic resistance, antibiotic stewardship programmes in primary and secondary care have introduced myriad prescribing and decision support tools in order to improve rates of appropriate antibiotic prescribing [1]
There was an increase in adherence to the Auckland City Hospital (ACH) antibiotic guidelines by prescribers caring for patients with community acquired pneumonia (CAP) from 19% (37/199) to 27% (64/237) in the intervention period (p = 0.04); but no change in guideline adherence at an adjacent hospital
There was no change in adherence to the antibiotic guidelines by prescribers caring for patients with urinary tract infections (UTIs) at ACH or at the two adjacent hospitals

Summary

Introduction

In response to the growing threat of antibiotic resistance, antibiotic stewardship programmes in primary and secondary care have introduced myriad prescribing and decision support tools in order to improve rates of appropriate antibiotic prescribing [1]. Whilst high levels of adherence to antibiotic guidelines result in improved patient safety, improved treatment outcomes, and reduced antibiotic resistance [1, 2], adherence to these guidelines often remains low [3,4,5]. The deployment of computerized decision support (CDS) on non-mobile platforms has repeatedly been shown to improve adherence to antibiotic guidelines, reduce mortality rates, and decrease the prevalence of antibiotic resistance [2]. Despite this evidence, the provision and uptake of CDS at a health system level remains low [7]. Mobile phone apps have been shown to enhance guideline adherence by prescribers, but have not been widely evaluated for their impact on guideline adherence by prescribers caring for inpatients with infections

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