Evaluation of a Smartphone Decision-Support Tool for Diarrheal Disease Management in a Resource-Limited Setting
Evaluation of a Smartphone Decision-Support Tool for Diarrheal Disease Management in a Resource-Limited Setting
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DOI：
10.1371/journal.pntd.0005290
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发表时间：
2017-01-01
影响因子：
3.8
通讯作者：
Nelson, Eric Jorge
中科院分区：
文献类型：
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作者：
Haque, Farhana;Ball, Robyn L.;Nelson, Eric Jorge
移动技术的出现为在资源有限的环境中改善临床指南的遵守提供了新的机会。我们在孟加拉国农村进行了一项临床试点研究，以评估智能手机适应世界卫生组织 (WHO) 腹泻病管理指南的影响，包括基于年龄的体重估计模式。软件开发以最终用户的意见为指导，并在 2015 年秋季霍乱季节期间在资源有限的区和分区医院进行了评估；两家医院都没有体重秤，因此需要估算体重。该研究包括 6 周的干预前和 6 周的干预期以及出院后 10 天的随访。除了入院临床医生在干预期间使用该工具外，整个研究过程中均保持护理标准。纳入标准是两个月及以上患有无并发症腹泻的患者。主要结果是遵守静脉（IV）液体、抗生素和锌处方指南。共有 841 名患者入组（325 名干预前患者；516 名干预患者）。干预期间，区医院和街道医院的静脉输液处方比例有所下降（均 p < 0.001），风险比 (RR) 分别为 0.5 和 0.2。然而，当开出静脉输液处方时，输液量更符合建议。推荐抗生素阿奇霉素的处方比例增加（p < 0.001 区；p = 0.035 分区），RR 为 6.9（区）和 1.6（分区），而其他抗生素的处方则减少；锌的附着力增加。局限性包括缺乏同时进行的对照组，并且在干预前没有独立的脱水评估。尽管存在局限性，但仍发现了改善临床护理的机会，包括更好的评估、体重估计和液体/抗生素选择。这些发现表明，基于智能手机的工具可以提高指南的遵守率。这项研究应成为随机对照试验的催化剂，以扩展研究结果并解决局限性。
The emergence of mobile technology offers new opportunities to improve clinical guideline adherence in resource-limited settings. We conducted a clinical pilot study in rural Bangladesh to evaluate the impact of a smartphone adaptation of the World Health Organization (WHO) diarrheal disease management guidelines, including a modality for age-based weight estimation. Software development was guided by end-user input and evaluated in a resource-limited district and sub-district hospital during the fall 2015 cholera season; both hospitals lacked scales which necessitated weight estimation. The study consisted of a 6 week pre-intervention and 6 week intervention period with a 10-day post-discharge follow-up. Standard of care was maintained throughout the study with the exception that admitting clinicians used the tool during the intervention. Inclusion criteria were patients two months of age and older with uncomplicated diarrheal disease. The primary outcome was adherence to guidelines for prescriptions of intravenous (IV) fluids, antibiotics and zinc. A total of 841 patients were enrolled (325 pre-intervention; 516 intervention). During the intervention, the proportion of prescriptions for IV fluids decreased at the district and sub-district hospitals (both p < 0.001) with risk ratios (RRs) of 0.5 and 0.2, respectively. However, when IV fluids were prescribed, the volume better adhered to recommendations. The proportion of prescriptions for the recommended antibiotic azithromycin increased (p < 0.001 district; p = 0.035 sub-district) with RRs of 6.9 (district) and 1.6 (sub-district) while prescriptions for other antibiotics decreased; zinc adherence increased. Limitations included an absence of a concurrent control group and no independent dehydration assessment during the pre-intervention. Despite limitations, opportunities were identified to improve clinical care, including better assessment, weight estimation, and fluid/antibiotic selection. These findings demonstrate that a smartphone-based tool can improve guideline adherence. This study should serve as a catalyst for a randomized controlled trial to expand on the findings and address limitations.