Effect of adding a mobile health intervention to a multimodal antimicrobial stewardship programme across three teaching hospitals: an interrupted time series study
Effect of adding a mobile health intervention to a multimodal antimicrobial stewardship programme across three teaching hospitals: an interrupted time series study
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DOI：
10.1093/jac/dkx040
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发表时间：
2017-06-01
影响因子：
5.2
通讯作者：
Holmes, A. H.
中科院分区：
文献类型：
--
作者：
Charani, E.;Gharbi, M.;Holmes, A. H.
目的：评估在已建立的抗菌药物管理计划 (ASP) 中添加抗生素处方移动医疗 (mHealth) 决策支持系统的影响。方法：2011 年 8 月，抗菌药物处方政策转换为移动应用程序 (app)。使用来自内科和外科病房每两年一次的点患病率调查的数据 (2008-14)，对中断时间序列进行分段回归分析，以评估该应用程序对处方指标的影响。实施前有 6 个数据点，实施后有 6 个数据点。结果：实施期间医学（6.48%，95% CI - -1.25 至 14.20）和外科（6.63%，95% CI = 0.15-13.10）两个专业的政策依从性（例如，遵循经验治疗或专家建议）有所增加，其中水平发生显着突然变化。手术（P < 0.05）。记录了停止/审查日期的处方百分比在医学（15.20%，95% CI = -17.81 至 48.22）和外科（35.97%，95% CI = -3.72 至 75.66）方面有所增加，但并不显着。医学（-16.25%，95% CI = -42.52 至 10.01）和外科（-14.62%，95% CI = -42.88 至 13.63）的适应症记录均有所减少。结论：将应用程序引入现有 ASP 对手术政策的合规性产生了重大影响，并对两个专业的停止/审查日期记录产生了积极但不显着的影响。由于现有的 ASP 工作，对第三个指标的负面影响可能反映了高水平的合规预干预。在数字平台上提供抗菌政策的更广泛价值，例如应使用对移动医疗干预措施更敏感的指标来衡量政策的覆盖范围和获取情况。
Objectives: To evaluate the impact of adding a mobile health (mHealth) decision support system for antibiotic prescribing to an established antimicrobial stewardship programme(ASP).Methods: 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.Results: 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).Conclusions: 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.