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Electronic decision support and diarrhoeal disease guideline adherence (mHDM): a cluster randomised controlled trial
- Source :
- Lancet Digit Health
- Publication Year :
- 2020
-
Abstract
- Summary Background Acute diarrhoeal disease management often requires rehydration alone without antibiotics. However, non-indicated antibiotics are frequently ordered and this is an important driver of antimicrobial resistance. The mHealth Diarrhoea Management (mHDM) trial aimed to establish whether electronic decision support improves rehydration and antibiotic guideline adherence in resource-limited settings. Methods A cluster randomised controlled trial was done at ten district hospitals in Bangladesh. Inclusion criteria were patients aged 2 months or older with uncomplicated acute diarrhoea. Admission orders were observed without intervention in the pre-intervention period, followed by randomisation to electronic (rehydration calculator) or paper formatted WHO guidelines for the intervention period. The primary outcome was rate of intravenous fluid ordered as a binary variable. Generalised linear mixed-effect models, accounting for hospital clustering, served as the analytical framework; the analysis was intention to treat. The trial is registered with ClinicalTrials.gov ( NCT03154229 ) and is completed. Findings From March 11 to Sept 10, 2018, 4975 patients (75·6%) of 6577 screened patients were enrolled. The intervention effect for the primary outcome showed no significant differences in rates of intravenous fluids ordered as a function of decision-support type. Intravenous fluid orders decreased by 0·9 percentage points for paper electronic decision support and 4·2 percentage points for electronic decision support, with a 4·2-point difference between decision-support types in the intervention period (paper 98·7% [95% CI 91·8–99·8] vs electronic 94·5% [72·2–99·1]; pinteraction=0·31). Adverse events such as complications and mortality events were uncommon and could not be statistically estimated. Interpretation Although intravenous fluid orders did not change, electronic decision support was associated with increases in the volume of intravenous fluid ordered and decreases in antibiotics ordered, which are consistent with WHO guidelines. Funding US National Institutes of Health.
- Subjects :
- Adult
Male
Paper
Diarrhea
medicine.medical_specialty
Technology
Adolescent
MEDLINE
Medicine (miscellaneous)
Health Informatics
World Health Organization
Article
law.invention
Young Adult
Health Information Management
Randomized controlled trial
law
Medicine
Humans
Decision Sciences (miscellaneous)
Cluster randomised controlled trial
Young adult
Medical prescription
Adverse effect
Child
mHealth
Decision Making, Computer-Assisted
Bangladesh
Intention-to-treat analysis
Primary Health Care
business.industry
Infant
Decision Support Systems, Clinical
Hospitals
Anti-Bacterial Agents
Prescriptions
Child, Preschool
Emergency medicine
Fluid Therapy
Administration, Intravenous
Female
Guideline Adherence
Electronics
business
Delivery of Health Care
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Lancet Digit Health
- Accession number :
- edsair.doi.dedup.....b017c21b605244b153742a9cd21b59a6