Improving Access to Antimicrobial Prescribing Guidelines in 4 African Countries: Development and Pilot Implementation of an App and Cross-Sectional Assessment of Attitudes and Behaviour Survey of Healthcare Workers and Patients
Abstract
:1. Introduction
2. Results
2.1. App Metrics 1 Year from Launch (April 2019–May 2020)
2.2. Cross-Sectional Survey Studies
2.2.1. Demographics
2.2.2. Patients
Patients’ Responses to the Use of Smartphone Mobile Apps in Healthcare Delivery
Patients’ Concerns with Their Health Professionals’ Use of Smartphone Apps by Age and Education
Patients’ Preferences for Health Professionals’ Use to Access Medicines Information
2.2.3. Healthcare Workers
Use of the CwPAMS App and Other Sources of Information
Use of the CwPAMS App and Other Sources of Information on Antimicrobial Prescribing by Profession
Assessment of Standard Treatment Guidelines and Drug Resistant Infections
Perception and Assessment of the CwPAMS Smartphone App
3. Discussion
3.1. CwPAMS App Metrics
3.2. Cross-Sectional Survey
3.3. Strengths and Limitations
4. Materials and Methods
4.1. Development of the App
4.2. Study Site
4.3. Study Design
4.4. Sample Size Determination/Sample Size and Sampling Technique
4.5. Procedure for Data Collection
4.5.1. CwPAMS App metrics
4.5.2. Pilot Cross-Sectional Survey
4.5.3. Study Approval
4.6. Procedure for Data Analysis
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- MacDougall, C.; Polk, R.E. Antimicrobial stewardship programs in health care systems. Clin. Microbiol. Rev. 2005, 18, 638–656. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Smith, C.; van Velthoven, M.H.; Truong, N.D.; Nam, N.H.; Anh, V.P.; AL-Ahdal, T.M.A.; Hassan, O.G.; Kouz, B.; Huy, N.T.; Brewster, M.; et al. How primary healthcare workers obtain information during consultations to aid safe prescribing in low-income and lower middle-income countries: A systematic review. BMJ Glob. Health 2020, 5, e002094. [Google Scholar] [CrossRef] [PubMed]
- Johns Hopkins ABX Guide App. Available online: http://www.unboundmedicine.com/products/johns_hopkins_abx_guide (accessed on 24 August 2015).
- Payne, K.F.; Weeks, L.; Dunning, P. A mixed methods pilot study to investigate the impact of a hospital-specific iPhone application (iTreat) within a British junior doctor cohort. Health Inform. J. 2014, 20, 59–73. [Google Scholar] [CrossRef] [PubMed]
- Horizon Strategic Partners. MicroGuide. Available online: http://www.microguide.eu/ (accessed on 27 August 2020).
- Panesar, P.; Jones, A.; Aldous, A.; Kranzer, K.; Halpin, E.; Fifer, H.; Macrae, B.; Curtis, C.; Pollara, G. Attitudes and behaviours to antimicrobial prescribing following introduction of a smartphone App. PLoS ONE 2016, 11, e0154202. [Google Scholar] [CrossRef] [PubMed]
- Tran, K.; Morra, D.; Lo, V.; Quan, S.D.; Abrams, H.; Wu, R.C. Medical students and personal smartphones in the clinical environment: The impact on confidentiality of personal health information and professionalism. J. Med. Internet Res. 2014, 16, e132. [Google Scholar] [CrossRef] [PubMed]
- Fox, S.; Duggan, M. Pew Research Center. Mobile Health 2012. Available online: https://www.pewresearch.org/internet/2012/11/08/mobile-health-2012/ (accessed on 7 May 2014).
- Kamerow, D. Regulating medical apps: Which ones and how much? BMJ 2013, 347, f6009. [Google Scholar] [CrossRef] [PubMed]
- Illiger, K.; von Jan, U.; Albrecht, U.V. Professional use of mobile devices at a university medical center. Biomed. Tech. 2014, 59, S691. [Google Scholar]
- Morris, M.E.; Aguilera, A. Mobile, social, and wearable computing and the evolution of psychological practice. Prof. Psychol. Res. Pract. 2012, 43, 622–626. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Patrick, K.; Griswold, W.G.; Raab, F.; Intille, S.S. Health and the mobile phone. Am. J. Prev. Med. 2008, 35, 177–181. [Google Scholar] [CrossRef] [PubMed]
- Preziosa, A.; Grassi, A.; Gaggioli, A.; Riva, G. Therapeutic applications of the mobile phone. Br. J. Guid. Counc. 2009, 37, 313–325. [Google Scholar] [CrossRef]
- Lane, N.; Mohammod, M.; Lin, M.; Yang, X.; Lu, H.; Ali, S.; Doryab, A.; Berke, E.; Choudhury, T.; Campbell, A.T. BeWell: A smartphone application to monitor, model and promote wellbeing. In Proceedings of the 5th International Conference on Pervasive Computing Technologies for Healthcare, Dublin, Ireland, 23–26 May 2011. [Google Scholar]
- Mascolo, C.; Musolesi, M.; Rentfrow, P.J. Mobile sensing for mass-scale behavioural intervention. In Proceedings of the NSF Workshop on Pervasive Computing at Scale (PeCS), University of Washington, Seattle, WA, USA, 27–28 January 2011. [Google Scholar]
- Rachuri, K.K.; Musolesi, M.; Mascolo, C.; Rentfrow, P.J.; Longworth, C.; Aucinas, A. EmotionSense: A mobile phones based adaptive platform for experimental social psychology research. In Proceedings of the 12th ACM International Conference on Ubiquitous Computing, Copenhagen, Danmark, 26–29 September 2010; pp. 281–290. [Google Scholar]
- Yardley, L. The potential of Internet-delivered behaviour change interventions. Eur. Health Psychol. 2011, 13, 40–43. [Google Scholar]
- Temitope, F. mHealth in Africa: Challenges and opportunities. Perspect. Public Health 2014, 134, 14. [Google Scholar]
- Gurmana, T.A.; Rubin, S.E.; Roess, A.A. Effectiveness of mHealth behavior change communication interventions in developing countries: A systematic review of the literature. J. Health Commun. 2012, 17, 82–104. [Google Scholar] [CrossRef] [PubMed]
- Buhi, E.R.; Trudnak, T.E.; Martinasek, M.P.; Oberne, A.B.; Fuhrmann, H.J.; McDermott, R.J. Mobile phone-based behavioural interventions for health: A systematic review. Health Educ. J. 2013, 72, 564–583. [Google Scholar] [CrossRef]
- Julian, S.; Christina, S. The Economics of eHealth and mHealth. J. Health Commun. 2012, 17, 73–81. [Google Scholar]
- Access and Delivery Partnership. Updates-FDA Launches Med Safety App to Improve Health Care Delivery in Ghana. Available online: https://www.adphealth.org/news/66/FDA-launches-Med-Safety-App-to-improve-health-care-delivery-in-Ghana.html (accessed on 20 August 2020).
- Chan, A.H.Y.; Rutter, V.; Ashiru-Oredope, D.; Tuck, C.; Babar, Z.-U.-D. Together we unite: The role of the Commonwealth in achieving universal health coverage through pharmaceutical care amidst the COVID-19 pandemic. J. Pharm. Policy Pract. 2020, 13, 13. [Google Scholar] [CrossRef] [PubMed]
- mPedigree. Recent News-Kenya’s e-Health Department has begun Piloting a System to Curb Fake Goods. Available online: https://mpedigree.com/news/kenyas-e-health-department-has-begun-piloting-a-system-to-curb-fake-goods-2/ (accessed on 20 August 2020).
- Smith, A. Pew Research Center. Older Adults and Technology Use. Available online: https://www.pewresearch.org/internet/2014/04/03/older-adults-and-technology-use/ (accessed on 3 April 2020).
- Wagner, N.; Hassanein, K.; Head, M. Computer use by older adults: A multi-disciplinary review. Comput. Hum. Behav. 2010, 26, 870–882. [Google Scholar] [CrossRef]
- Wu, R.; Rossos, P.; Quan, S.; Reeves, S.; Lo, V.; Wong, B.; Cheung, M.; Morra, D. An evaluation of the use of smartphones to communicate between clinicians: A mixed-methods study. J. Med. Internet Res. 2011, 13, e59. [Google Scholar] [CrossRef] [PubMed]
- Hsieh, C.; Yun, D.; Bhatia, A.C.; Hsu, J.T.; Ruiz de Luzuriaga, A.M. Patient perception on the usage of smartphones for medical photography and for reference in dermatology. Dermatol. Surg. 2015, 41, 149–154. [Google Scholar] [CrossRef] [PubMed]
- Lester, R.; Haigh, K.; Wood, A.; MacPherson, E.E.; Maheswaran, H.; Bogue, P.; Hanger, S.; Kalizang’oma, A.; Srirathan, V.; Kulapani, D.; et al. Sustained reduction in third-generation cephalosporin usage in adult inpatients following introduction of an antimicrobial stewardship program in a large urban hospital in Malawi. Clin. Infect. Dis. 2020. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) App Metrics | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
2019 | 2020 | Total (%) | |||||||||||||
Months | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | |
Downloads (n) | |||||||||||||||
12 | 20 | 75 | 21 | 67 | 66 | 124 | 27 | 28 | 27 | 9 | 9 | 40 | 100 | ||
Guide Opens (n) | |||||||||||||||
35 | 36 | 26 | 354 | 237 | 453 | 375 | 457 | 147 | 141 | 130 | 127 | 122 | 155 | 100 | |
National Guideline Page Hits by Country (n) | |||||||||||||||
Ghana | 40 | 17 | 569 | 176 | 399 | 827 | 438 | 192 | 141 | 375 | 243 | 126 | 46 | 50.3 | |
Tanzania | 3 | 11 | 101 | 21 | 20 | 53 | 307 | 73 | 25 | 27 | 187 | 73 | 22 | 13 | |
Uganda | 21 | 81 | 196 | 223 | 663 | 322 | 368 | 64 | 101 | 96 | 10 | 13 | 45 | 31 | |
Zambia | 2 | - | 15 | 4 | 8 | 9 | 74 | 4 | 3 | 0 | 4 | 10 | 4 | 1.9 | |
Nil | 17 | 7 | 65 | 27 | 19 | 23 | 39 | 10 | 24 | 3 | 19 | 15 | 6 | 3.8 | |
Individual Page Hits by App Sections (n) | |||||||||||||||
About the CwPAMS App | 13 | 9 | 57 | 39 | 44 | 31 | 71 | 11 | 13 | 8 | 19 | 16 | 37 | 3.4 | |
Userguide | 3 | 4 | 58 | 31 | 38 | 29 | 58 | 17 | 17 | 8 | 9 | 22 | 15 | 2.9 | |
National Prescribing Guidelines | 83 | 116 | 946 | 451 | 1109 | 1234 | 1226 | 343 | 294 | 501 | 463 | 237 | 119 | 66.1 | |
Access, Watch, Reserve (AWaRE)—WHO Essential Medicines List | 132 | 17 | 140 | 212 | 184 | 54 | 202 | 45 | 39 | 18 | 40 | 49 | 42 | 11.0 | |
Antimicrobial Stewardship (AMS) Tools | 21 | 3 | 84 | 143 | 89 | 40 | 72 | 17 | 36 | 10 | 25 | 18 | 27 | 5.5 | |
Training on AMS | 26 | 4 | 105 | 105 | 66 | 46 | 51 | 7 | 33 | 10 | 20 | 10 | 4 | 4.5 | |
Infection Prevention and Control | 6 | 5 | 91 | 61 | 42 | 24 | 70 | 24 | 17 | 7 | 16 | 23 | 18 | 3.7 | |
Antimicrobial Use Surveillance | 11 | 2 | 44 | 43 | 39 | 15 | 26 | 8 | 14 | 4 | 11 | 16 | 3 | 2.2 | |
Updates on Antimicrobial Resistance (AMR)—Coming Soon | 4 | 1 | 8 | 7 | 7 | 9 | 11 | 0 | 11 | 1 | 0 | 8 | 0 | 0.7 |
Profession | CwPAMS App Metrics (By Profession) | ||
---|---|---|---|
Registered Users | Downloads | Guide Opens | |
Dentistry | 1 | 2 | 2 |
Physiotherapy | 1 | 0 | 0 |
Clinical science | 3 | 0 | 0 |
Healthcare management | 6 | 2 | 1 |
Paramedic | 6 | 1 | 1 |
Biomedical scientist | 15 | 3 | 11 |
Physician Associate | 15 | 1 | 12 |
Medicine | 84 | 57 | 80 |
Nursing | 103 | 29 | 36 |
Pharmacy | 258 | 159 | 274 |
Other | 13 | 2 | 3 |
Patients | |||||||
---|---|---|---|---|---|---|---|
Highest Level of Education Obtained | |||||||
Basic Primary Education | Secondary Education | Tertiary Education | No data provided | ||||
4 | 23 | 19 | 1 | ||||
Age | |||||||
<18 | 18–25 | 26–35 | 36–45 | 46–55 | 56–67 | 68 above | Nil |
1 | 25 | 7 | 1 | 3 | 5 | 3 | 2 |
Health Professionals | |||||||
Profession | |||||||
Doctor | Pharmacist | Nurse | Others | ||||
4 | 6 | 18 | 10 |
Questions/Comments | Score (%) | ||||
---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | |
What do you feel about the following? | |||||
I am pleased with my doctor assessing a smart phone app while attending to me | 21.3 | 36.2 | 23.4 | 6.4 | 12.8 |
Using smart phone apps will increase the quality of healthcare offered by my doctor | 25.5 | 31.9 | 19.1 | 17.0 | 6.4 |
The use of smart phone apps quickens access to healthcare | 17.0 | 40.4 | 25.5 | 12.8 | 4.3 |
The use of smart phone apps increases quality of healthcare delivery | 14.9 | 36.2 | 36.2 | 6.4 | 6.4 |
Do you have any reservations/concerns with a doctor’s use of a mobile app while attending to you? If yes, what are your concerns? | |||||
The doctor may not be competent enough | 4.3 | 17.0 | 8.5 | 10.6 | 12.8 |
It is a distraction to healthcare provision | 4.3 | 25.5 | 12.8 | 10.6 | 2.1 |
My data may not be protected/secured | 6.4 | 21.3 | 10.6 | 8.5 | 4.3 |
Mobile devices may not be technically reliable enough | 6.4 | 21.3 | 10.6 | 17.0 | 0 |
The use of smart phones/mobile apps may be complicated when it comes to healthcare | 4.3 | 17.0 | 12.8 | 17.0 | 2.1 |
Frequency of Accessing Medical Information (%) | ||||||
---|---|---|---|---|---|---|
Device | Daily | More than once a day | Weekly | Monthly | Never | Nil |
Mobile phone | 28.9 | 60.5 | 5.3 | 2.6 | 0 | 2.6 |
Tablet | 7.9 | 13.2 | 5.3 | 0 | 47.4 | 26.3 |
Computer | 7.9 | 10.5 | 5.3 | 26.3 | 21.0 | 28.9 |
Pocket book | 10.5 | 2.6 | 13.2 | 10.5 | 28.9 | 34.2 |
Printed posters | 13.2 | 15.8 | 7.9 | 13.2 | 26.3 | 23.7 |
Others | 0 | 5.3 | 0 | 0 | 5.3 | 89.5 |
Frequency of Accessing Antimicrobial Prescribing Information (%) | ||||||
CwPAMS App | 2.6 | 5.3 | 7.9 | 2.6 | 63.2 | 18.4 |
Printed copy of standard treatment guidelines | 26.3 | 21.0 | 0 | 21.0 | 13.2 | 18.4 |
British National Formulary (BNF)/National guidelines | 28.9 | 23.7 | 10.5 | 15.8 | 10.5 | 10.5 |
Microbiology/Infectious disease advice | 13.2 | 10.5 | 15.8 | 7.9 | 31.6 | 21.0 |
Pharmacists | 18.4 | 31.6 | 7.9 | 15.8 | 13.2 | 13.2 |
Senior colleagues | 26.3 | 36.8 | 7.9 | 13.2 | 2.6 | 13.2 |
Other junior doctors | 26.3 | 26.3 | 2.6 | 10.5 | 18.4 | 15.8 |
Internet search engines (e.g., Google) | 18.4 | 50.0 | 13.2 | 2.6 | 2.6 | 13.2 |
Others | 0 | 0 | 0 | 0 | 2.6 | 97.4 |
Questions/Comments | Score | ||||
---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | |
Assessment of standard treatment guidelines and attitude to Antimicrobial Resistance (%) (n = 38) | |||||
Standard antimicrobial treatment guidelines are easy to access | 15.8 | 63.2 | 10.5 | 5.3 | 5.3 |
My seniors’ preferences guide antimicrobial prescribing more than standard treatment guidelines | 7.9 | 36.8 | 26.4 | 15.8 | 2.6 |
Standard antimicrobial treatment guidelines don’t apply to my patients | 7.9 | 5.3 | 13.2 | 42.1 | 26.4 |
I prefer to use non-standard treatment guidelines to guide my antimicrobial prescribing | 5.3 | 13.2 | 7.9 | 36.8 | 28.9 |
I am concerned about the emergence of drug-resistant infections | 50 | 44.7 | 0 | 0 | 0 |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Olaoye, O.; Tuck, C.; Khor, W.P.; McMenamin, R.; Hudson, L.; Northall, M.; Panford-Quainoo, E.; Asima, D.M.; Ashiru-Oredope, D. Improving Access to Antimicrobial Prescribing Guidelines in 4 African Countries: Development and Pilot Implementation of an App and Cross-Sectional Assessment of Attitudes and Behaviour Survey of Healthcare Workers and Patients. Antibiotics 2020, 9, 555. https://doi.org/10.3390/antibiotics9090555
Olaoye O, Tuck C, Khor WP, McMenamin R, Hudson L, Northall M, Panford-Quainoo E, Asima DM, Ashiru-Oredope D. Improving Access to Antimicrobial Prescribing Guidelines in 4 African Countries: Development and Pilot Implementation of an App and Cross-Sectional Assessment of Attitudes and Behaviour Survey of Healthcare Workers and Patients. Antibiotics. 2020; 9(9):555. https://doi.org/10.3390/antibiotics9090555
Chicago/Turabian StyleOlaoye, Omotayo, Chloe Tuck, Wei Ping Khor, Roisin McMenamin, Luke Hudson, Mike Northall, Edwin Panford-Quainoo, Derrick Mawuena Asima, and Diane Ashiru-Oredope. 2020. "Improving Access to Antimicrobial Prescribing Guidelines in 4 African Countries: Development and Pilot Implementation of an App and Cross-Sectional Assessment of Attitudes and Behaviour Survey of Healthcare Workers and Patients" Antibiotics 9, no. 9: 555. https://doi.org/10.3390/antibiotics9090555