The Use of Mobile Educational Tools to Improve Antimicrobial Prescription for the Treatment of Acute Pyelonephritis in Pregnancy: A Retrospective Cross-sectional Study

Abstract

Objective To analyze the prescription of antimicrobial agents for pregnant women admitted into the obstetrics service who presented with acute pyelonephritis.

Methods Three cross-sectional studies were performed comparing the prescription of antimicrobials for pyelonephritis in pregnant women in the time periods evaluated (2010–2011: 99 patients evaluated; 2013: 116 patients evaluated; 2015: 107 patients evaluated), at the Hospital Fêmina, Porto Alegre, in the state of Rio Grande do Sul, Brazil. The analysis was performed before and after the promotion of an institutional protocol for the treatment of pyelonephritis during pregnancy, and on a third occasion after the introduction of a smartphone-based mobile educational tool.

Results The evaluation of the prescribing physicians and the adequacy of the prescriptions between the different periods studied revealed a significant increase in appropriate conduct for the choice of antimicrobial (2010: 83.8%; 2013: 95.7%; and 2015: 100%), route of administration (2010: 97%; 2013: 100%; and 2015: 100%), and interval (2010: 91.9%; 2013: 95.7%; and 2015: 100%), following the introduction of the protocol, and again after the implementation of the software application with orientations on the antimicrobial treatment.

Conclusion The use of specific mobile applications should be encouraged to attain a better quality and accuracy in prescriptions and to include strategies that not only reduce the risk of negative outcomes, but also improve the quality of care and treatment for maintaining the health both of the mother and of the baby.

Resumo

Objetivo Analisar a prescrição de antimicrobianos para gestantes admitidas no serviço de obstetrícia que apresentaram pielonefrite aguda.

Métodos Foram realizados três estudos transversais comparando a prescrição de antimicrobianos para pielonefrite em gestantes nos períodos avaliados (2010–2011: 99 indivíduos avaliados; 2013: 116 indivíduos avaliados; 2015: 107 indivíduos avaliados), no Hospital Fêmina, Porto Alegre, RS, Brasil. A análise foi realizada antes e após a promoção de um protocolo institucional para o tratamento da pielonefrite durante a gravidez e, em uma terceira ocasião, após a introdução de uma ferramenta educacional móvel para uso por smartphone.

Resultados A avaliação das prescrições médicas e a adequação das prescrições entre os diferentes períodos estudados revelaram um aumento significativo na conduta adequada para a escolha do antimicrobiano (2010: 83,8%; 2013: 95,7%; e 2015: 100%), via de administração (2010: 97%; 2013: 100%; e 2015: 100%) e intervalo (2010: 91,9%; 2013: 95,7%; e 2015: 100%), após a introdução do protocolo, e novamente após a implementação do aplicativo com orientações sobre tratamento antimicrobiano.

Conclusão O uso de aplicativos móveis específicos deve ser incentivado para obter melhor qualidade e precisão nas prescrições e incluir estratégias que não apenas reduzam o risco de resultados negativos, mas que também melhorem a qualidade dos cuidados e do tratamento para manter a saúde conjunta da mãe e do bebê.

Keywords

urinary tract infections - pregnancy - medical education - medical informatics application

Palavras-chave

infecções do trato urinário - gestação - educação médica - aplicações de informática médica

Contributions

Antonello V. S., Jimenez M. F., Antonello I. C. F., and Bumaguin D. B. participated in the revision of the manuscript. Antonello V. S., Jimenez M. F., Antonello I. C. F., and Bumaguin D. B participated in the design, the draft and in the revision of the study. Cunegatto, M. C., Rosin E. T., Castilhos J. X., Beduschi F. G., and Antonello V. S evaluated the medical records of the case and control patients. Antonello V. S and Jimenez M. F. conceived the study and participated in its design, its coordination and in the drafting of the manuscript. All of the authors read and approved the final manuscript.

• References

• 1 Subhi Y, Bube SH, Rolskov Bojsen S, Skou Thomsen AS, Konge L. Expert involvment and adherence to medical evidence in medical mobile phone apps: a systematic review. JMIR Mhealth Uhealth 2015; 3 (03) e79 . Doi: 10.2196/mhealth.4169
• 2 Payne KB, Wharrad H, Watts K. Smartphone and medical related App use among medical students and junior doctors in the United Kingdom (UK): a regional survey. BMC Med Inform Decis Mak 2012; 12: 121 . Doi: 10.1186/1472-6947-12-121
• 3 Hardyman W, Bullock A, Brown A, Carter-Ingram S, Stacey M. Mobile technology supporting trainee doctors' workplace learning and patient care: an evaluation. BMC Med Educ 2013; 13: 6 . Doi: 10.1186/1472-6920-13-6
• 4 Johnson E, Emani VK, Ren J. Breadth of coverage, ease of use, and quality of mobile point-of-care tool information summaries: an evaluation. JMIR Mhealth Uhealth 2016; 4 (04) e117 . Doi: 10.2196/mhealth.6189
• 5 Smaill FM, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev 2015; (08) CD000490 . Doi: 10.1002/14651858.CD000490.pub3
• 6 Schito GC, Naber KG, Botto H. , et al. The ARESC study: an international survey on the antimicrobial resistance of pathogens involved in uncomplicated urinary tract infections. Int J Antimicrob Agents 2009; 34 (05) 407-413 . Doi: 10.1016/j.ijantimicag.2009.04.012
• 7 Wing DA, Fassett MJ, Getahun D. Acute pyelonephritis in pregnancy: an 18-year retrospective analysis. Am J Obstet Gynecol 2014; 210 (03) 219.e1-219.e6 . Doi: 10.1016/j.ajog.2013.10.006
• 8 Schenkel DF, Dallé J, Antonello VS. [Microbial etiology and susceptibility of community urinary tract infections during pregnancy in the south of Brazil]. Rev Bras Ginecol Obstet 2014; 36 (03) 102-106 . Doi: 10.1590/S0100-72032014000300002
• 9 Gupta K, Hooton TM, Naber KG. , et al; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011; 52 (05) e103-e120 . Doi: 10.1093/cid/ciq257
• 10 Franko OI, Tirrell TF. Smartphone app use among medical providers in ACGME training programs. J Med Syst 2012; 36 (05) 3135-3139 . Doi: 10.1007/s10916-011-9798-7
• 11 Wiechmann W, Kwan D, Bokarius A, Toohey SL. There's an app for that? Highlighting the difficulty in finding clinically relevant smartphone applications. West J Emerg Med 2016; 17 (02) 191-194 . Doi: 10.5811/westjem.2015.12.28781
• 12 Baig MM, GholamHosseini H, Moqeem AA, Mirza F, Lindén M. Clinical decision support systems in hospital care using ubiquitous devices: Current issues and challenges. Health Informatics J 2017; 1460458217740722: 1460458217740722 . Doi: 10.1177/1460458217740722
• 13 Nori P, Madaline T, Munjal I. , et al. Developing interactive antimicrobial stewardship and infection prevention curricula for diverse learners: a tailored approach. Open Forum Infect Dis 2017; 4 (03) ofx117 . Doi: 10.1093/ofid/ofx117
• 14 Liu Y, Ren W, Qiu Y, Liu J, Yin P, Ren J. The use of mobile phone and medical apps among general practitioners in Hangzhou City, Eastern China. JMIR Mhealth Uhealth 2016; 4 (02) e64 . Doi: 10.2196/mhealth.4508
• 15 Ozdalga E, Ozdalga A, Ahuja N. The smartphone in medicine: a review of current and potential use among physicians and students. J Med Internet Res 2012; 14 (05) e128 . Doi: 10.2196/jmir.1994