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Antibiotic prescription using a digital decision support system: a register-based study of patients with hard-to-heal ulcers in Sweden
Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden ; Blekinge Wound Healing Centre, Region Blekinge, Karlshamn, Sweden.
Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden ; Department of Research, Region Kalmar län, Kalmar, Sweden.
Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden ; Blekinge Centre of Competence, Region Blekinge, Karlskrona, Sweden.
University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.ORCID iD: 0000-0001-9870-8477
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2022 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 10, article id e060683Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To investigate differences in antibiotic prescription for patients with hard-to-heal ulcers assessed using a digital decision support system (DDSS) compared with those assessed without using a DDSS. A further aim was to examine predictors for antibiotic prescription. DESIGN: Register-based study. SETTING: In 2018-2019, healthcare staff in primary, community and specialist care in Sweden tested a DDSS that offers a mobile application for data and photograph transfer to a platform for multidisciplinary consultation and automatic transmission of data to the Registry of Ulcer Treatment (RUT). Register-based data from patients assessed and diagnosed using the DDSS combined with the RUT was compared with register-based data from patients whose assessments were merely registered in the RUT. PARTICIPANTS: A total of 117 patients assessed using the DDSS combined with the RUT (the study group) were compared with 1784 patients whose assessments were registered in the RUT without using the DDSS (the control group). PRIMARY AND SECONDARY OUTCOME MEASURES: The differences in antibiotic prescription were analysed using the Pearson's χ2 test. A logistic regression analysis was used to check for influencing factors on antibiotic prescription. RESULTS: Patients assessed using a DDSS in combination with the RUT had significantly lower antibiotic prescription than patients entered in the RUT without using the DDSS (8% vs 26%) (p=0.002) (only healed ulcers included). Predictors for antibiotic prescription were diabetes; long healing time; having an arterial, neuropathic or malignant ulcer. CONCLUSIONS: A DDSS with data and photograph transfer that enables multidisciplinary communication appears to be a suitable tool to reduce antibiotic prescription for patients with hard-to-heal ulcers. 

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2022. Vol. 12, no 10, article id e060683
Keywords [en]
Anti-Bacterial Agents, Humans, Prescriptions, Sweden, Ulcer, Wound Healing, antiinfective agent, human, prescription, Infection control, PRIMARY CARE, Telemedicine, WOUND MANAGEMENT
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Social and Clinical Pharmacy
Identifiers
URN: urn:nbn:se:his:diva-22034DOI: 10.1136/bmjopen-2021-060683ISI: 000877107000018PubMedID: 36302578Scopus ID: 2-s2.0-85140860751OAI: oai:DiVA.org:his-22034DiVA, id: diva2:1709853
Funder
Region Blekinge, LTB-939727
Note

CC BY-NC 4.0

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

October 2022

Correspondence to Dr Hanna Linnea Wickström; hanna.wickstrom@med.lu.se

The study was partly funded by the Scientific Committee of Blekinge County, Council's Research and Development Foundation as part of a PhD studentship (LTB-939727).

Available from: 2022-11-10 Created: 2022-11-10 Last updated: 2023-08-28Bibliographically approved

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Anderberg, Peter

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