Evaluation of a Smartphone Decision-Support Tool for Diarrheal Disease Management in a Resource-Limited Setting
| العنوان: | Evaluation of a Smartphone Decision-Support Tool for Diarrheal Disease Management in a Resource-Limited Setting |
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| المؤلفون: | Mohammod Jobayer Chisti, Farhana Haque, Robyn L. Ball, Jason R. Andrews, Korrapati Teja Vardhan, Shafiqul Alam Sarker, Mahmudur Rahman, Muhammad Waliur Rahman, Eric J. Nelson, Mujaddeed Ahmed, Nancy A. Federspiel, Saraswati Kache, Selina Khatun, Dane Pieri, Clea Sarnquist, Stace Maples |
| المصدر: | PLoS Neglected Tropical Diseases PLoS Neglected Tropical Diseases, Vol 11, Iss 1, p e0005290 (2017) |
| بيانات النشر: | Public Library of Science (PLoS), 2017. |
| سنة النشر: | 2017 |
| مصطلحات موضوعية: | Male, Bacterial Diseases, Medical Doctors, Health Care Providers, Pilot Projects, Azithromycin, Pathology and Laboratory Medicine, law.invention, Geographical Locations, 0302 clinical medicine, Cholera, Randomized controlled trial, Antibiotics, law, Medicine and Health Sciences, Medicine, 030212 general & internal medicine, Child, Dehydration (Medicine), Bangladesh, Dehydration, Antimicrobials, lcsh:Public aspects of medicine, Drugs, Anti-Bacterial Agents, 3. Good health, Zinc, Professions, Diarrhea, Infectious Diseases, Research Design, Child, Preschool, Health Resources, Engineering and Technology, Female, Guideline Adherence, Smartphone, medicine.symptom, Research Article, Neglected Tropical Diseases, medicine.drug, medicine.medical_specialty, lcsh:Arctic medicine. Tropical medicine, Asia, Adolescent, lcsh:RC955-962, 030231 tropical medicine, MEDLINE, Equipment, Gastroenterology and Hepatology, Research and Analysis Methods, Microbiology, 03 medical and health sciences, Signs and Symptoms, Diagnostic Medicine, Microbial Control, Physicians, Intervention (counseling), Humans, Medical prescription, Intensive care medicine, Pharmacology, Communication Equipment, business.industry, Public Health, Environmental and Occupational Health, Infant, Biology and Life Sciences, lcsh:RA1-1270, Pilot Studies, Tropical Diseases, medicine.disease, Health Care, Relative risk, People and Places, Population Groupings, Cell Phones, business |
| الوصف: | The emergence of mobile technology offers new opportunities to improve clinical guideline adherence in resource-limited settings. We conducted a clinical pilot study in rural Bangladesh to evaluate the impact of a smartphone adaptation of the World Health Organization (WHO) diarrheal disease management guidelines, including a modality for age-based weight estimation. Software development was guided by end-user input and evaluated in a resource-limited district and sub-district hospital during the fall 2015 cholera season; both hospitals lacked scales which necessitated weight estimation. The study consisted of a 6 week pre-intervention and 6 week intervention period with a 10-day post-discharge follow-up. Standard of care was maintained throughout the study with the exception that admitting clinicians used the tool during the intervention. Inclusion criteria were patients two months of age and older with uncomplicated diarrheal disease. The primary outcome was adherence to guidelines for prescriptions of intravenous (IV) fluids, antibiotics and zinc. A total of 841 patients were enrolled (325 pre-intervention; 516 intervention). During the intervention, the proportion of prescriptions for IV fluids decreased at the district and sub-district hospitals (both p < 0.001) with risk ratios (RRs) of 0.5 and 0.2, respectively. However, when IV fluids were prescribed, the volume better adhered to recommendations. The proportion of prescriptions for the recommended antibiotic azithromycin increased (p < 0.001 district; p = 0.035 sub-district) with RRs of 6.9 (district) and 1.6 (sub-district) while prescriptions for other antibiotics decreased; zinc adherence increased. Limitations included an absence of a concurrent control group and no independent dehydration assessment during the pre-intervention. Despite limitations, opportunities were identified to improve clinical care, including better assessment, weight estimation, and fluid/ antibiotic selection. These findings demonstrate that a smartphone-based tool can improve guideline adherence. This study should serve as a catalyst for a randomized controlled trial to expand on the findings and address limitations. Author Summary Diarrheal disease is responsible for one in ten deaths among children less than five years of age globally. Innovative interventions to address gaps in the clinical care of these patients are lacking, yet will likely reduce the morbidity and mortality from diarrheal diseases. Therefore, the objective of this pilot study was to take a technology-enabled approach to improve guideline adherence, including antibiotic selection for diarrheal disease management in a resource-limited setting. To do this we adapted WHO guidelines to a smartphone platform and evaluated the approach in Bangladesh at two rural hospitals. The platform was durable and demonstrated positive improvement in guideline adherence. The results suggest that the decision-support tool was associated with a decrease in intravenous fluid use while maintaining safety, an increase in use of the recommended antibiotic, and a decrease in use of medications not recommended. This study represents a critical first step towards technology-enabled decision-support tools for diarrheal disease in resource-limited settings. |
| تدمد: | 1935-2735 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b48fd51ac6fdedfc2d4afab6b3986bec https://doi.org/10.1371/journal.pntd.0005290 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....b48fd51ac6fdedfc2d4afab6b3986bec |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19352735 |
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