title: An Evidence-Based Antimicrobial Stewardship Smartphone App for Hospital Outpatients: Survey-based Needs Assessment Among Patients.
abstract: BACKGROUND
  Current advances in modern technology have enabled the development and utilization of electronic medical software apps for both mobile and desktop computing devices. A range of apps on a large variety of clinical conditions for patients and the public are available, but very few target antimicrobials or infections.
  
  
  OBJECTIVE
  We sought to explore the use of different antimicrobial information resources with a focus on electronic platforms, including apps for portable devices, by outpatients at two large, geographically distinct National Health Service (NHS) teaching hospital trusts in England. We wanted to determine whether there is demand for an evidence-based app for patients, to garner their perceptions around infections/antimicrobial prescribing, and to describe patients' experiences of their interactions with health care professionals in relation to this topic.
  
  
  METHODS
  A cross-sectional survey design was used to investigate aspects of antimicrobial prescribing and electronic devices experienced by patients at four hospitals in London and a teaching hospital in the East of England.
  
  
  RESULTS
  A total of 99 surveys were completed and analyzed. A total of 82% (80/98) of respondents had recently been prescribed antimicrobials; 87% (85/98) of respondents were prescribed an antimicrobial by a hospital doctor or through their general practitioner (GP) in primary care. Respondents wanted information on the etiology (42/65, 65%) and prevention and/or management (32/65, 49%) of their infections, with the infections reported being upper and lower respiratory tract, urinary tract, oral, and skin and soft tissue infections. All patients (92/92, 100%) desired specific information on the antimicrobial prescribed. Approximately half (52/95, 55%) stated it was "fine" for doctors to use a mobile phone/tablet computer during the consultation while 13% (12/95) did not support the idea of doctors accessing health care information in this way. Although only 30% (27/89) of respondents reported on the use of health care apps, 95% (81/85) offered information regarding aspects of antimicrobials or infections that could be provided through a tailored app for patients. Analysis of the comments revealed the following main global themes: knowledge, technology, and patient experience.
  
  
  CONCLUSIONS
  The majority of respondents in our study wanted to have specific etiological and/or infection management advice. All required antimicrobial-related information. Also, most supported the use of electronic resources of information, including apps, by their doctors. While a minority of people currently use health apps, many feel that apps could be used to provide additional support/information related to infections and appropriate use of antimicrobials. In addition, we found that there is a need for health care professionals to engage with patients and help address common misconceptions around the generation of antimicrobial resistance.
authors.affiliation: National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College, London, United Kingdom. c.micallef@imperial.ac.uk.
authors.forename: Christianne
authors.identifier: http://orcid.org/0000-0002-4513-8199
authors.initials: C
authors.lastname: Micallef
authors.forename: Monsey
authors.identifier: http://orcid.org/0000-0001-5571-2417
authors.initials: M
authors.lastname: McLeod
authors.forename: Enrique
authors.identifier: http://orcid.org/0000-0002-3351-9496
authors.initials: E
authors.lastname: Castro-Sánchez
authors.forename: Myriam
authors.identifier: http://orcid.org/0000-0002-8994-2816
authors.initials: M
authors.lastname: Gharbi
authors.forename: Esmita
authors.identifier: http://orcid.org/0000-0002-5938-1202
authors.initials: E
authors.lastname: Charani
authors.forename: Luke Sp
authors.identifier: http://orcid.org/0000-0001-7095-7922
authors.initials: LS
authors.lastname: Moore
authors.forename: Mark
authors.identifier: http://orcid.org/0000-0003-4529-0243
authors.initials: M
authors.lastname: Gilchrist
authors.forename: Fran
authors.identifier: http://orcid.org/0000-0001-9823-1533
authors.initials: F
authors.lastname: Husson
authors.forename: Ceire
authors.identifier: http://orcid.org/0000-0002-3475-7525
authors.initials: C
authors.lastname: Costelloe
authors.forename: Alison H
authors.identifier: http://orcid.org/0000-0001-5554-5743
authors.initials: AH
authors.lastname: Holmes
keywords: antimicrobial resistance; mHealth; mobile electronic devices; mobile health; patient involvement