A mobile health tool to improve antibiotic stewardship among village doctors in Bangladesh

移动医疗工具可改善孟加拉国乡村医生的抗生素管理

• 批准号: 10527016
• 负责人: Ashraful Islam Khan
• 金额: $ 19.8万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-19 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10527016
• 关键词: 5 year old; Accounting; Acute Diarrhea; Age; Antibiotics; Antimicrobial Resistance; Bangladesh; Blood; Breast Feeding; Car Phone; Caregivers; Cause of Death; Cessation of life; Child; Childhood; Climate; Clinical; Clinical Management; Collaborations; Cross-Over Trials; Custom; Data; Development; Diagnosis; Diagnostic; Diarrhea; Drug Prescriptions; Etiology; Feasibility Studies; Feces; Fever; Fostering; Goals; Habits; Health; Health Personnel; Healthcare; Individual; Knowledge; Laboratories; Lead; Location; Measures; Medical; Methods; Mobile Health Application; Modeling; Modification; Morbidity - disease rate; Patient Care; Patients; Performance; Phase; Physicians; Population; Prevalence; Primary Health Care; Provider; Randomized; Randomized Controlled Trials; Rehydrations; Rural; Site; Syndrome; Testing; Toxic effect; Training; Trust; Viral; Vomiting; Work; acceptability and feasibility; antimicrobial; base; care costs; clinical application; clinical decision support; clinical decision-making; cost; diarrheal disease; evidence base; feasibility trial; implementation strategy; improved; innovation; low and middle-income countries; mHealth; mortality; pathogen; predictive modeling; predictive tools; research and development; respiratory; rural area; rural healthcare; rural setting; support tools; tool

Abstract Diarrheal diseases are the among the leading cause of death in children worldwide, most of which occur in low- and middle-income countries (LMICs). The cornerstone for management of diarrhea is rehydration, though antimicrobials are beneficial in some instances. Unfortunately, given that treatment is frequently empiric, based mostly on clinical suspicion for bacterial causes, antimicrobials are overused in management of diarrheal illness worldwide. Thus, there is a need for clinical decision support tools to inform clinical management and promote antimicrobial stewardship. In particular, frontline healthcare providers in rural areas, such as village doctors in Bangladesh, often have inadequate knowledge for the basis of antimicrobial use, and may benefit greatly from guidance. We have recently developed a mobile phone based electronic clinical decision-support tool (eCDST), and shown the impact of etiological prediction on physician antibiotic prescription practices for pediatric diarrhea in two LMICs. In this proposal, our overarching goal is to customize our eCDST into a comprehensive mHealth application (Accessible Diarrhea Etiology Prediction Tool, ADEPT) to support rural health care providers in the management of pediatric diarrhea (R21 phase), and to measure its impact through the performance of a pilot before-after feasibility study (R33 phase). Our work will contribute to an evidence base for mHealth-enabled antimicrobial stewardship, with potential to extend beyond diarrheal illness, and into other syndromes, including respiratory illness and febrile illness.

抽象的 腹泻病是全世界儿童死亡的主要原因之一，其中大多数发生在 低收入和中等收入国家 (LMIC)。不过，治疗腹泻的基石是补液 抗菌药物在某些情况下是有益的。不幸的是，鉴于治疗通常是经验性的、基于 主要是由于临床怀疑是由细菌引起的，抗菌药物在腹泻的治疗中被过度使用 全世界的疾病。因此，需要临床决策支持工具来为临床管理和治疗提供信息。 促进抗菌药物管理。特别是乡村等农村地区的一线医疗服务提供者 孟加拉国的医生往往对抗菌药物使用的基础知识不足，并且可能会受益 很大程度上来自指导。我们最近开发了基于手机的电子临床决策支持 工具（eCDST），并显示了病原学预测对医生抗生素处方实践的影响 两个中低收入国家的小儿腹泻。在本提案中，我们的首要目标是将 eCDST 定制为 全面的移动医疗应用程序（无障碍腹泻病因预测工具，ADEPT）支持农村地区 医疗保健提供者管理小儿腹泻（R21 阶段），并通过以下方式衡量其影响： 试点前后可行性研究（R33 阶段）的表现。我们的工作将有助于提供证据 移动医疗支持的抗菌药物管理的基础，有可能超越腹泻疾病，并进入 其他综合症，包括呼吸道疾病和发热性疾病。