Development And Evaluation Of A Web-based Support System For Rational Antibiotics Use For Village Doctors

Objective The objectives of this study mainly include two aspects.The first is to research and develop a simple and practical web-based assistance system for the rational use of antibacterial drugs to help and promote the continuous improvement of the use of antibiotics by village clinic doctors and raise the awareness of villagers on antibiotics,thereby reducing the occurrence and harm of antimicrobial resistance.The second is to evaluate the effectiveness of the auxiliary system through pilot application.Methods 1)The design of Web-based support system adopted a series of methods.such as,literature review,soft system thinking,preliminary prototype system design,expert consultation and pilot optimization;2)The evaluation on the system adopted "intervention and control","baseline and post-intervention" design;3)Through stratified cluster random sampling,24 administrative villages in 12 counties in 3 districts of Anhui Province were selected as the investigation points;4)according to the principle of proximity to revolve,one household was selected randomly as the starting household from the above survey sites.120 households were selected randomly,and only one villager each household was qualified(a total of 2880 included);5)Undergraduates or postgraduate students studying in medical school as investigators.With the help of relevant personnel(investigation area doctors or nurses),one-on-one and face-to-face survey was conducted;6)Epidata 3.1 software was used for data entry,and SPSS 18.0 software was used for data processing analysis respectively.First,the socio-demographic characteristics(including gender,age,and education)of the respondents were described.Then variance analysis and chi-square test were used to compare the socio-demographic characteristics between baseline and post-intervention groups.Finaly,chi-square test was then used to compare the differences between baseline and post-intervention groups,and intervention and control groups.The following indicators were compared:Antibiotic-related knowledge,behavior and attitude;Indicative infections;The prevalence of antibiotics use;Capabilities of coping and preventing infectious disease;Implementation of key diagnostic activities.In addition,univariate logistic regression was used to analyze the influencing factors of antibiotic use.Result The study yielded some steps for the admission of six types of common infections and some specific operating procedures established for each treatment step,and designed a convenient and practical online assistance system to facilitate the implementation of the above-mentioned procedures and procedures.After applying the assistant system for a period of 9 months(July 22,2015 to May 11,2016),there is a statistically significant improvement was found in the following four indicators between the baseline and the post-intervention groups and the intervention and control groups.The first is the reduction in the use of antimicrobials: 1)54.4% in the intervention group and 92.6% in the baseline group;2)78.8% in the intervention group and 92.5% in the control group.Followed by the increase in the implementation rate of key diagnosis and treatment activities for infections: 1)The proportion of providing 4 or more diagnosis and treatment activities of the intervention groups was higher than the control group(P=0.000),which was 25.6% and 12.2% respectively;2)The proportions of “inquiry”,medical history,analysis of dietary therapy,analysis of antimicrobial therapy,counseling for disease response,and consultation for infection prevention of the intervention group were higher than these in the control group(P<0.05),which were 44.2%> 28.2%,20.1%> > 3.5%,12.3%> 2.4%,14.0%> 6.3% and 11.4%> 2.7% respectively.The third is the improvement of knowledge,behaviors,and attitudes related to antibiotics and infections among villagers: 1)The proportion of“think antibiotics that can kill or control viral infection” of the post-intervention group is lower than the baseline group(83.0%<91.6%);The intervention group was lower than the control group(74.0%<82.7%);2)As the ratio of antimicrobial effectiveness on the common cold,fever and diarrhea,the post-intervention group were considered to be lower than the baseline group,which was 64.6%<70.0%,55.4%<79.1% and 44.2%<72.0% respectively;the intervention group was lower than the control group,73.7%<81.1%,64.0%<72.4% and 56.8%<66.1% respectively;3)The proportions of 2,3 and more infections response and prevention knowledge on respiratory tract infection of the intervention group were higher than the control group,which were 19.9%<11.1%,15.9%<2.9% respectively,and 22.9%<18.7%,14.4%<3.5% respectively.The fourth is the decrease in the incidence of indication infections: the incidence of respiratory and gastrointestinal infections of the post-intervention group was lower than the baseline group,which was 39.3% <63.4% and 13.9% <16.3% respectively.Univariate logistic regression analysis found that sex and age were not influencing factors of tantibiotics use,and the degree of education was related to the use of antibiotics to a certain extent;key diagnosis and treatment activities and villagers' knowledge about antibiotics may be the influencing factors of antimicrobial use(P<0.05).Conclusion 1)The Web-based assistant system can effectively control the use of antibiotics at least in the short term;2)The use of Web-based assistant system can improve clinician's diagnosis and treatment activities;3)The system may provide a low cost and sustainable solution for the phenomenon of overuse of antibiotics in rural Anhui.