Protocol for the development and validation of e-health tools to support clinical decision and patient empowerment in respiratory infections

Antibiotic resistance is one of the major public health problems world-wide. Inappropriate use of antibiotics is currently regarded as the main determinant of such resistance, which is closely related to literacy on the topic1. The rise in antibiotic resistance makes tackling respiratory tract infections (RTI) in all populations a global health-care concern.2 Several studies demonstrate that educational strategies prove to be effective and have direct positive impact on antibiotic use and antibiotic resistance.3 In parallel, clinical decision support systems have also proven their effectiveness in improving clinical decision regarding appropriate antibiotic prescription. 4 The main objective of eHealthResp is to evaluate the effectiveness of e-Health tools to support clinical decision and patient empowerment in RTI management. An intervention that will consist of outreach visits will take place. An online course, a clinical decision support system for the physicians and pharmacists and a mobile app for patients is also being developed, which will consist in the presentation of 5 clinical cases (pharyngitis, otitis media, bronchitis, rhinosinusitis and community-acquired pneumonia) and questions about the diagnosis and treatment of each RTI. To evaluate the effectiveness of the intervention, a cluster randomized controlled trial covering all general practitioners and community pharmacists in Centre Region of Portugal, will be performed. A pilot study will be conducted prior to the cluster trial, with the objective of validating applications, with 20 primary care physicians, 20 community pharmacists, and 50 patients.As response variables, indicators of the prescribing/dispensing of antibiotics will be assessed. By merging educational and e-health strategies, eHealthResp is expected to obtain significantly positive results regarding antibiotic literacy, use, prescription and dispensing. Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest The authors declare no conflict of interest.This work was financially supported by the project POCI-01-0145-FEDER-031678, funded by FEDER, through COMPETE2020 - Programa Operacional Competitividade e Internacionalização (POCI), and by national funds (OE), through FCT/MCTES. References and Clinical Trial Registry Information World Health Organization [WHO]. Antibiotic Resistance: Multi-country public awareness survey [Internet]. 2015 [cited 2020 Jan 3]. Available from: www.who.int Guitor AK, Wright GD. Antimicrobial Resistance and Respiratory Infections. Vol. 154, Chest. Elsevier Inc; 2018. p. 1202–12. Roque F, Herdeiro MT, Soares S, Rodrigues AT, Breitenfeld L, Figueiras A. Educational interventions to improve prescription and dispensing of antibiotics: A systematic review. BMC Public Health. 2014;14(1). Rittmann B, Stevens MP. Clinical Decision Support Systems and Their Role in Antibiotic Stewardship: a Systematic Review. Vol. 21, Current Infectious Disease Reports. Current Medicine Group LLC 1; 2019.