Implementation of an antibiotic stewardship clinical decision support tool and its impact on attitudes and behaviors towards antibiotic prescribing in a low-middle-income country

• Published in: Journal of global antimicrobial resistance. 2024-12, Vol.39, p.29-29
• Main Authors: Nasir, Nosheen, Mehmood, Beenish Khalid, Awan, Safia, Sattar, Saadia, Tajuddin, Salma, Qureshi, Sonia
• Format: Article
• Language: English
• Subjects: Antibiotic Stewardship; Clinical Decision Support tool; mhealth
• ISSN: 2213-7165
• DOI: 10.1016/j.jgar.2024.10.089

Antimicrobial stewardship programs are limited in resources to provide real-time assistance with antibiotic prescribing in healthcare settings in low-middle-income countries. The potential of clinical decision support systems (CDSS) for improving antibiotic stewardship efforts in resource-constrained settings is largely unexplored. Our study aims to assess physicians' attitudes and behaviors towards antibiotic prescribing, and the impact of a CDSS tool on prescribing practices at a tertiary care center in Karachi, Pakistan. A cross-sectional pre and post-CDSS intervention survey was conducted among all physicians prescribing antibiotics and data was collected on a pre-tested questionnaire on antibiotic use, antimicrobial stewardship, and source of information. Of the 263 physicians who responded to the survey, 63.5% (n=167) were females and the majority 54.4% (n=142) were practicing medicine. 33.9% (89/263) of the physicians were unaware of the institutional antibiotic guidelines. 66% (111/168) were not satisfied with the current electronic pdf-based guideline format. Furthermore, 52.6% of physicians proposed that the availability of a mobile application would greatly enhance access to the guidelines. After the mhealth-based CDSS intervention (Figure 1) the accessibility of guidelines via mobile applications and the internet increased from 7.69% to 17.58% and 15.64% to 24.18% respectively. Additionally, there was an improvement in adherence to hospital guidelines from 29.6% to 31.65% (Figures 2 and 3). Our study identified barriers to resource utilization for appropriate antibiotic prescribing which led to the development of a local guideline-based clinical decision support system and resulted in better guideline adherence among the prescribing physicians.