JMIR Publications

ABSTRACT

Background:

Suboptimal use of antibiotics is a driver of antimicrobial resistance (AMR) in West Africa. Clinical decision support tools (CDSS) can facilitate access to updated and reliable recommendations.

Objective:

This study aimed to assess contextual factors that could facilitate the implementation of a CDSS for antimicrobial prescribing in West Africa and Central Africa and to identify tailored implementation strategies.

Methods:

This qualitative study was conducted through twenty-one semi-structured individual interviews by video conference with healthcare professionals between September and December 2020. The interview guide included multiple constructs derived from CFIR - the Consolidated Framework for Implementation Research. Data were analyzed using thematic analysis.

Results:

The panel of participants included health practitioners (12/21, 57%), health actors trained in engineering (2/21, 9%), project managers (3/21, 14%), microbiologists and biologists (1/21, 5%), antimicrobial resistance experts (2/21, 10%), and anthropologists (1/21, 5%). Contextual factors influencing the implementation of E-health tools existed at the individual, healthcare system and national levels. At the individual level, the main challenge was to design a user-centered CDSS adapted to prescriber’s clinical routine and structural constraints. Most of the participants stated that the CDSS should target physicians in academic hospitals who can use their network to disseminate the tool but also general practitioners, primary care nurses, midwives and other healthcare workers who are the main prescribers of antimicrobials in rural areas of West Africa. The heterogeneity in antimicrobial prescribing training among prescribers was a significant challenge to the use of a common CDSS. At the country level, weak pharmaceutical regulations, lack of official guidelines for antimicrobial prescribing, limited access to clinical microbiology laboratories, self-medication and disparity in healthcare coverage led to inappropriate antibiotic use and could limit the implementation and diffusion of CDSS for antimicrobial prescribing. Participants emphasized the importance of building a solid e-health ecosystem in their countries by establishing academic partnerships, developing physician networks and involving diverse stakeholders to address challenges. Additional implementation strategies included conducting local needs assessment, identifying early adopters, promoting network weaving, using implementation advisers or creating a learning collaborative. Participants noted that a CDSS for antimicrobial prescribing could be a powerful tool for the development and dissemination of official guidelines for infectious diseases in West Africa.

Conclusions:

These results confirm the relevance of a CDSS for non-specialized physicians in West Africa. It also confirms the relevance of adopting a cross-disciplinary approach with participants from different backgrounds to assess contextual factors including social, political, economic determinants.