JMIR Publications

ABSTRACT

Background:

Inappropriate antibiotic prescribing is one of the key contributors to antibiotic resistance and could potentially be resolved with appropriate health professions education. Digital education has the potential to improve the quality of healthcare professionals’ antibiotic management.

Objective:

The objectives of this systematic review were to evaluate the effectiveness of digital education for antibiotic management compared with various controls in improving healthcare professionals’ knowledge, skills, attitudes, satisfaction, clinical practice, economic outcomes and patient-related outcomes.

Methods:

Seven electronic databases and two trial registries were searched for randomized controlled trials (RCTs) and cluster RCTs published between January 1, 1990 and September 20, 2018. There were no language restrictions. We followed Cochrane methods to select studies, extract data and to appraise and synthesize eligible studies.

Results:

Six cluster RCTs and two RCTs with 655 primary healthcare practices, 1392 primary care physicians and 485,632 patients were included. The interventions included personal digital assistants, short text messages, online digital education including emails and websites, and online blended education which used a combination of online digital education and traditional education materials. The control groups received traditional education. Six studies assessed post-intervention clinical practice. The majority of the studies (4 out of 6 studies) reported greater reduction in antibiotics prescription or dispensing rate with digital education compared to traditional education. Two studies showed significant difference in post-intervention knowledge scores in favour of mobile education compared with traditional education [standardized mean difference (SMD)=1.09, 95% CI 0.90 to 1.28, I2=0%, large effect size, 491 participants (2 studies)]. The findings about healthcare professionals’ attitudes and patient-related outcomes were mixed or inconclusive. Three studies found digital education to be more cost-effective than traditional education. None of the included studies reported on skills, satisfaction or adverse effects.

Conclusions:

Our findings suggest that mobile digital education and/or online digital education (standalone or in blended format) on antibiotic management could improve primary care physicians’ post-intervention knowledge, clinical practice and be cost-effective particularly in post-registration scenarios. Future research should focus on the use of emerging technologies (such as serious games, virtual reality, and virtual patient simulations) in training healthcare professionals, within a range of settings (including low- and middle-income countries) and report on outcomes such as attitudes, skills, adverse effects, patient outcomes and economic impact.