Health Professions Digital Education for Antibiotic Management: A Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

Background: Inappropriate antibiotic prescribing is one of the key contributors to antibiotic resistance that is tackled with a range of interventions including education. We aimed to summarise the evidence on effectiveness of digital education of antibiotic management compared to traditional in improving healthcare professionals' knowledge, skills, attitudes and clinical practice. Methods: Seven electronic databases and two trial registries were searched for randomised controlled trials (RCTs) and cluster RCTs published between January 1, 1990 and September 20, 2018. There were no language restrictions. We followed Cochrane methods to select studies, extract data and to appraise and synthesise eligible studies. Findings: Six cluster RCTs and two RCTs with 655 primary healthcare practices, 1392 primary care physicians and 485,632 patients were included. The interventions included personal digital assistants, short text messages, online digital education including emails and websites, and online blended education which used a combination of online digital education and traditional education materials. The control groups received traditional education. Six studies assessed post-intervention clinical practice. The majority of the studies (4 out of 6 studies) reported greater reduction in antibiotics prescription or dispensing rate with digital education compared to traditional education. Two studies showed significant difference in post-intervention knowledge scores in favour of mobile education compared with traditional education [standardised mean difference (SMD)=1.09, 95% CI 0.90 to 1.28, I2=0%, large effect size, 491 participants (2 studies)]. The findings about healthcare professionals' attitudes and patient-related outcomes were mixed or inconclusive. Three studies found digital education to be more cost-effective than traditional education. None of the included studies reported on skills, satisfaction or adverse effects. Interpretation: Findings from studies deploying mobile and/or online modalities of digital education on antibiotic management were complementary and found to be more cost-effective than traditional education in improving clinical practice and post-intervention knowledge particularly in post-registration settings. There is a lack of evidence on the effectiveness of other digital education modalities such as virtual reality, or serious games. Future studies should also include healthcare professionals working in other settings than primary care, and in low- and middle-income countries. Funding Statement: Funding support is from Lee Kong Chian School of Medicine Start-Up Grant, Nanyang Technological University Singapore, Singapore. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: We carried out a systematic review and meta-analysis by following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. The protocol for this review was registered in PROSPERO (CRD 42018109742).