一个数字健康算法来指导儿童门诊护理中的抗生素处方:一个集群随机对照试验
Rainer Tan1,2,3,4, Godfrey Kavishe5, Lameck B Luwanda6
1Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland. rainer.tan@unisante.ch.
Nature medicine
|December 19, 2023
概括
一个数字工具ePOCT+显著减少了坦桑尼亚儿童的抗生素处方,表明它是一种安全有效的抗抗菌素耐药性的策略,而不会影响临床结果.
科学领域:
- 全球健康 全球健康
- 传染性疾病 传染性疾病
- 数字健康数字健康
背景情况:
- 抗菌素耐药性 (AMR) 是一个关键的全球健康挑战.
- 在初级保健中过度使用抗生素有助于AMR.
- 需要有效的工具来指导对患病儿童的抗生素处方.
研究的目的:
- 评估电子临床决策支持工具ePOCT+对坦桑尼亚急性疾病儿童抗生素处方的影响.
- 为了比较ePOCT+与常规护理的临床有效性和安全性.
主要方法:
- 一个集群随机对照试验在坦桑尼亚的初级保健设施中进行.
- ePOCT+ 集成的C反应蛋白检测,血红蛋白检测,脉冲氧计和指导.
- 在11个月内分析了ePOCT+设施中的23,593次咨询和通常护理设施中的20,713次咨询.
主要成果:
- 与常规护理 (70.1%) 相比,ePOCT+ (23.2%) 的抗生素处方率明显较低.
- 在ePOCT+和常规护理组之间,第7天的临床失败是不劣的 (aRR为0.97,95% CI为0.85至1.10).
- 在死亡或住院等二次安全结果中没有发现显著差异.
结论:
- ePOCT+数字工具有效地减少了初级保健机构不必要的抗生素处方.
- ePOCT+提供了一种安全而可行的策略,用于对抗儿科护理中的抗菌素耐药性.
- 数字健康干预措施显示出改善全球抗生素管理的前景.
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