电子临床决策支持算法 (eCDSA) 对柬埔寨初级保健中的抗生素处方的影响:一个集群随机对照试验
Elke Wynberg1, Abhijit Mishra2, Marco Liverani3
1Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam University Medical Centers (UMC), Amsterdam, the Netherlands.
概括
电子临床决策支持算法 (eCDSA) 并没有减少柬埔寨初级保健中的抗生素处方. 未来的干预措施需要更好的培训和医疗保健工作者的参与,以改善处方行为.
科学领域:
- 全球健康 全球健康
- 传染性疾病 传染性疾病
- 医疗信息学 医疗信息学
背景情况:
- 抗生素耐药性是一个重大威胁,主要是由于初级保健中不适当的处方.
- 电子临床决策支持算法 (eCDSAs) 整合临床检测显示了改善抗生素处方的潜力.
- 这项研究评估了eCDSA对柬埔寨初级卫生中心发烧患者抗生素使用的影响.
研究的目的:
- 评估eCDSA在减少初级保健机构发烧患者抗生素处方方面的有效性.
- 评估eCDSA对医院转诊率和患者康复的影响.
- 在资源有限的环境中确定影响eCDSAs采用和有效性的因素.
主要方法:
- 在柬埔寨的30个初级卫生中心 (PHC) 进行了集群随机对照试验.
- 干预组使用了eCDSA,将临床评估与脉冲氧计和C反应蛋白测试相结合.
- 抗生素处方率在eCDSA组和常规护理组之间使用通用线性混合模型进行了比较.
主要成果:
- 在eCDSA和对照组之间没有观察到抗生素处方率的显著差异 (aOR 0.64;p=0.44).
- 尽管eCDSA的建议,几乎一半的患者不适用于抗生素仍然收到处方.
- 转诊率很低 (2.0%),大多数患者报告在7天内康复 (94.3%).
结论:
- 评估的eCDSA没有有效地减少这种初级保健环境中的抗生素处方.
- 对eCDSA建议的遵守率较低,凸显出需要加强对医疗保健工作者的培训和参与.
- 未来的eCDSA开发应该侧重于当地适应和与前线医疗保健实践的更深层次的整合,以影响处方行为.
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