A digital antimicrobial stewardship smartphone application to combat AMR: the AB-assistant
Antimicrobials are an indispensable part of modern medicine. However, optimal prescription of these agents is becoming increasingly challenging because of the growing complexity of guidelines, and constantly changing epidemiology. Moreover, due to local variations in the prevalence of certain pathogens and antimicrobial resistance, antimicrobial choices need to be tailored to local epidemiology. Improvement of antimicrobial use , in particular prevention of overuse of (broadspectrum) antibiotics, through antimicrobial stewardship (AMS) programs is increasingly regarded as indispensable, both to optimize therapy for the individual patients as well as to reduce emergence of resistance . With the widespread use of electronic health records and handheld electronic devices in hospitals, informatics-based AMS interventions hold great promise as tools to improve antimicrobial prescribing. However, they are still underdeveloped, understudied and underutilized. We propose the development and evaluation of AB-assistant, a smartphone based digital stewardship app that is customizable to local guidelines and therefore has the potential to be used worldwide, including in low- and middleincome countries. AB-assistant will build on the significant experience in the development and implementation of electronic tools for AMS by the partners participating in this proposal. Furthermore, the app will be available for the two most common mobile operating systems: iOS and Android. In this project we propose to 1) develop an AB-assistant app based on the existing Spectrum app (Calgary; www.thespectrumapp.com) with improvements to enhance AMS in large parts of the world 2) test the usability of this app in different countries to determine barriers and facilitators 3) evaluate the AB-assistant in an international, multicentre, randomized clinical trial involving centres in 4 countries in different settings with appropriate antimicrobial use as a primary outcome and 4) use factors identified in this study to facilitate further customization and worldwide implementation of AB-assistant. This unique proposal aims to develop a digital steward for use in different countries worldwide which will increase adherence to prescription guidelines and reduce antimicrobial resistance.
- Annelies Verbon, Erasmus MC University Medical Center, Netherlands (Coordinator)
- Thomas Tängdén, Uppsala University, Sweden (Partner)
- Benedikt Huttner, University Hospitals Geneva, Switzerland (Partner)
- John Conly, University of Calgary, Canada (Partner)
- Marlies Hulscher, Radboud University Medical Center, Netherlands (Observer)
- Christina Grosu, University of Medicine and Pharmacy, Bucharest, Romania (Observer)
- Helena Zemlickova, Charles University, Czech Republic (Observer)
- Johan Mouton, Erasmus MC University Medical Center, Netherlands (Observer)
Background: Antimicrobials are an indispensable part of modern medicine. However, optimal prescription of these agents is becoming increasingly challenging because of the growing complexity of guidelines, and constantly changing epidemiology. With the widespread use of electronic health records and handheld electronic devices in hospitals, informatics-based AMS interventions hold great promise as tools to improve antimicrobial prescribing. Methods: In this study, we aim to develop and evaluate the AB-assistant, a smartphone based digital stewardship app that is customizable to local guidelines of hospitals. The project is a collaboration between hospitals in the Netherlands, Switzerland, Sweden, and Canada and has started at February 1, 2018. A pilot study determining the potential barriers and facilitators for using the app in different languages and cultures is part of the project. The impact of the AB assistant on appropriate antibiotic prescribing will be evaluated in a large randomized study in the Netherlands, Sweden and Switzerland. Hospitals in the Caribbean and Africa will also participate in (part of) the study. Results: 1) An existing app (Spectrum MD) has been adapted to the AB assistant in a project with partners in the Netherlands, Canada, Sweden and Switzerland. The app is now available for use in all these countries. 2) A content management system was added so that changes can be easily made in the app by participating hospitals. 3) A pilot study with this app in the Netherlands, Switzerland and Sweden to determine barriers and facilitators for its use has been done and data were used to improve the app and to develop a quantitative questionnaire. 4) Preparations for the evaluation of the AB-assistant in an clinical trial such as IRB approval; selection of participating wards; a study record form tested with vignet patients; randomization program and whitelisting system for users are in place. The actual trial has been started. 5)approached African and Caribbean countries agreed to participate in the study 6) the app has been presented at national SWAB symposia and the protocol has been published in a Medical Journal.