African Journal of Public Health and Health Systems | 28 May 2017
A Comparative Study of Mobile Application-Based Clinical Decision Support and Its Effect on Appropriate Paediatric Antibiotic Prescribing in Maputo's Outpatient Clinics
C, a, r, l, o, s, N, h, a, m, p, o, s, s, a, ,, A, n, a, M, u, n, g, u, a, m, b, e
Abstract
Inappropriate antibiotic prescribing in paediatric outpatient settings is a major driver of antimicrobial resistance. In low-resource settings, prescribers often lack ready access to current guidelines. Mobile health interventions, including clinical decision support systems, present a potential means to improve adherence to prescribing standards. This study compared the effect of a mobile application-based clinical decision support system against standard paper-based guidelines on the appropriateness of antibiotic prescriptions for children under five years of age in Maputo’s outpatient clinics. A comparative study was conducted across multiple public outpatient clinics in Maputo. Clinics were allocated to an intervention group, where prescribers used a bespoke mobile application clinical decision support system, or a control group using standard paper guidelines. Retrospective analysis of prescription records for common childhood illnesses was performed to assess appropriateness against national treatment guidelines. Data were analysed using comparative statistical methods. Prescriptions from clinics using the mobile clinical decision support system showed a statistically significant improvement in appropriateness. The proportion of appropriate antibiotic prescriptions was 78% in the intervention group, compared to 52% in the control group. The most notable improvement was observed for acute respiratory infections. The mobile application-based clinical decision support system was associated with a higher rate of appropriate paediatric antibiotic prescribing compared to traditional paper guidelines in this setting. This suggests such mHealth tools can support clinical decision-making within antimicrobial stewardship programmes. Integration of similar mobile clinical decision support systems into routine outpatient practice should be considered. Further research is needed to assess long-term sustainability, cost-effectiveness, and impact on clinical outcomes and resistance patterns. antimicrobial stewardship, clinical decision support systems, mHealth, paediatrics, antibiotic prescribing, Mozambique, low-resource settings This study provides comparative evidence from a low-resource African context on the utility of a mobile clinical decision support system to improve paediatric antibiotic prescribing.