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: 10707328
• 负责人: Ashraful Islam Khan
• 金额: $ 18.47万
• 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/10707328
• 关键词: 5 year old; Accounting; Acute Diarrhea; Age; Antibiotics; Antimicrobial Resistance; Bangladesh; Blood; Breast Feeding; Caregivers; Cause of Death; Cellular Phone; Cessation of life; Child; Childhood; Climate; Clinical; Clinical Management; Collaborations; Cross-Over Trials; Data; Development; Diagnosis; Diagnostic; Diarrhea; Drug Prescriptions; Electronics; Etiology; Feasibility Studies; Feces; Fever; Fostering; Goals; Habits; Health; Health Personnel; Healthcare; Hydration status; Individual; Knowledge; Laboratories; Location; Maps; Measures; Medical; Methods; Mobile Health Application; Modeling; Modification; Morbidity - disease rate; Patient Care; Patients; Performance; Phase; Physicians; Population; Prevalence; Primary Care; Provider; Randomized; Randomized, Controlled Trials; Rural; Seasons; Site; Syndrome; Testing; Toxic effect; Training; Trust; Viral; Vomiting; Work; acceptability and feasibility; antimicrobial; care costs; clinical application; clinical decision support; clinical decision-making; clinical predictive model; cost; diarrheal disease; evidence base; feasibility trial; health training; implementation strategy; improved; innovation; low and middle-income countries; mHealth; mortality; pathogen; predictive tools; research and development; respiratory; rural area; rural healthcare; rural setting; support tools; tool; 5 year old; Accounting; Acute Diarrhea; Age; Antibiotics; Antimicrobial Resistance; Bangladesh; Blood; Breast Feeding; Caregivers; Cause of Death; Cellular Phone; Cessation of life; Child; Childhood; Climate; Clinical; Clinical Management; Collaborations; Cross-Over Trials; Data; Development; Diagnosis; Diagnostic; Diarrhea; Drug Prescriptions; Electronics; Etiology; Feasibility Studies; Feces; Fever; Fostering; Goals; Habits; Health; Health Personnel; Healthcare; Hydration status; Individual; Knowledge; Laboratories; Location; Maps; Measures; Medical; Methods; Mobile Health Application; Modeling; Modification; Morbidity - disease rate; Patient Care; Patients; Performance; Phase; Physicians; Population; Prevalence; Primary Care; Provider; Randomized; Randomized, Controlled Trials; Rural; Seasons; Site; Syndrome; Testing; Toxic effect; Training; Trust; Viral; Vomiting; Work; acceptability and feasibility; antimicrobial; care costs; clinical application; clinical decision support; clinical decision-making; clinical predictive model; cost; diarrheal disease; evidence base; feasibility trial; health training; implementation strategy; improved; innovation; low and middle-income countries; mHealth; mortality; pathogen; 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 腹泻疾病是全球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）。腹泻管理​​的基石是补液，尽管 在某些情况下，抗菌剂是有益的。不幸的是，鉴于治疗经常是经验性的，基于 主要是关于细菌原因的临床怀疑，抗菌素在腹泻的治疗中被过度使用 全球疾病。因此，需要临床决策支持工具，以告知临床管理和 促进抗菌管理。特别是，农村地区的一线医疗保健提供者，例如村庄 孟加拉国的医生通常对抗菌使用的知识不足，并且可能受益 大大来自指导。我们最近开发了一个基于手机的电子临床决策支持 工具（ECDST），并显示了病因预测对医师抗生素处方实践的影响 两种LMIC的小儿腹泻。在此提案中，我们的总体目标是将我们的ECDST自定义为 全面的MHealth应用程序（可访问的腹泻病因预测工具，熟练）支持农村 儿科腹泻管理（R21阶段）的医疗保健提供者，并通过 试验前可行性研究（R33阶段）的表现。我们的工作将有助于证据 实现MHealth支持的抗菌药物的基础，有可能超越腹泻病，并进入 其他综合症，包括呼吸道疾病和高热疾病。