Lao Anti-Microbial Prescribing Guidelines Mobile Phone Application (LAMPA)

The overall aim of this study is to compare the proportion of antimicrobial prescriptions adherent with prescribing guidelines delivered by mobile phone application (app) versus paper-based prescribing guidelines in both in- and outpatients in six hospitals in Laos. This is an open cohort stepped-wedge cluster randomized controlled trial 3-step trial (4-month intervals at each step) with a 4-month pre-intervention period). The study conducts in six hospitals across Laos. This is 16 months-study. The intervention is a MicroGuide antimicrobial prescribing guideline mobile phone application and antimicrobial stewardship (AMS) training; whilst the reference is paper-based antimicrobial prescribing guidelines. The main outcome of interest is the proportion of antimicrobial prescriptions adherent with prescribing guidelines delivered by app-based versus paper-based prescribing guidelines at month 16 (12 months' exposure in each group). Outcome measurements are Point prevalence surveys (PPS) of hospital antimicrobial use, prescriber questionnaires and AMS knowledge survey of the prescribers. Simple random sampling will be used to select the order (step) of interventions implementation for a group of hospitals (two hospitals per group and one group per step). Neither hospitals nor investigators are blinded to the timing of intervention. Open Data Kit (ODK) system will be used as data collection instrument. All data will be kept securely, protected by password access with automatic daily backup. A logistic mixed-effects regression model will be used to compare the proportion of antimicrobial prescription adherence measured cross-sectionally at month 0, 4, 8, 12 and month 16 after introduction of prescribing guidelines delivered by mobile phone application versus paper-based. This study was approved by University of Health Sciences, Vientiane, Lao PDR and Oxford Tropical Ethics Committee (OxTREC), University of Oxford, United Kingdom.