JMIR Publications

ABSTRACT

Background:

Suboptimal use of antibiotics is a driver of antimicrobial resistance. Clinical decision support systems (CDSS) for antimicrobial prescribing can assist prescribers with rapid access to up to date information. In low- and middle-income countries, in particular, introduction of CDSS for antimicrobial prescribing could have measurable impact. However, the adoption of CDSS in routine clinical care and their sustainability are often limited and interventions to implement them are challenging due to cultural and structural constraints. Pre-implementation research is needed to ensure relevant adaptation and fit with the adopting context.

Objective:

Our objective was to study the requirements for a CDSS for antibiotic prescribing in primary care adapted to the context of West Africa and to analyse the barriers and facilitators to its use. We aimed to understand potential benefits and risks of implementing a CDSS and to ensure co-designed solutions.

Methods:

We organised a workshop in Burkina Faso in June 2019 with 47 healthcare professionals (19 women and 38 men) representing 9 West African countries and 6 medical specialties. The workshop included the presentation of a CDSS for antibiotic prescribing (Antibioclic), followed by a roundtable discussion and completion of an individual questionnaire with open-ended questions. Qualitative data were analysed using thematic analysis.

Results:

Most of the participants had access to a smartphone during their clinical consultations (n=35, 74%) but only 49% had access to a computer and none used CDSS for antimicrobial prescribing. The participants considered that a CDSS could have a number of positive consequences ranging from updating the knowledge of practitioners on antimicrobial prescribing, impact in terms of improving clinical care and reducing antimicrobial resistance (AMR), as well as encouraging the establishment of national guidelines and developing surveillance capabilities in primary care. The most frequently cited contextual barrier to implementing a CDSS was the potential risk of increasing self-medication in West Africa where antibiotics can be bought without prescription. The need for the CDSS to be tailored to the local epidemiology of infectious diseases and AMR was highlighted along with the availability of diagnostic tests and antimicrobial drugs using national guidelines where available. Participants endorsed co-design as central to any introduction of CDSS involving health professionals and other stakeholders including nurses, midwives and pharmacists. A phased approach was suggested by initiating and evaluating CDSS in a pilot site followed by dissemination using traditional professional networks and social media. The lack of widespread internet access and computers could be circumvented by the development of a mobile application with an offline mode.

Conclusions:

Our study provides valuable information to develop and implement a CDSS for antibiotic prescribing among primary care prescribers in LMICs and may in turn contribute to improving antimicrobial use, clinical outcomes and decreasing AMR.