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

• Published in: Journal of antimicrobial chemotherapy 2017-06, Vol.72 (6), p.1825-1831
• Main Authors: Charani, E, Gharbi, M, Moore, L S P, Castro-Sanchéz, E, Lawson, W, Gilchrist, M, Holmes, A H
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Anti-Infective Agents - therapeutic use; Decision Support Systems, Clinical; Drug Prescriptions - standards; Drug Prescriptions - statistics & numerical data; Guideline Adherence; Hospitals, Teaching; Humans; Interrupted Time Series Analysis; Mobile Applications; Original Research; Practice Patterns, Physicians; Telemedicine - legislation & jurisprudence; Telemedicine - methods
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkx040

To evaluate the impact of adding a mobile health (mHealth) decision support system for antibiotic prescribing to an established antimicrobial stewardship programme (ASP). 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. 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). 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.