The problem
Specific antibiotics challenges remain within primary care. While the number of CDI cases in secondary care is falling, the number attributable to primary care is on the increase. Compliance with primary care antimicrobial guidance is now subject to national audit in Scotland. Recognition of the need to improve primary care antibiotic prescribing is evidenced by the publication of a recent multi-faceted antibiotic prescribing education programme for GPs (STAR trial 2012) and development of the TARGET antibiotic toolkit by the Royal College of General Practitioners.
We are part of NHS Greater Glasgow & Clyde (NHS GGC)’s Antimicrobial Utilisation Committee (AUC). We regularly review and update local antimicrobial prescribing guidance developed from that issued by the Health Protection Agency and Public Health England. But we wanted to improve awareness and access to our antimicrobial guidelines within primary care in order to help improve compliance. Given that the smartphone is an increasingly ubiquitous tool for the modern GP, it seemed that an app would provide handy portable access to guidance complementing existing avenues on the web and via posters.
In addition, it would be an educational tool for doctors in training and increase awareness of our efforts internationally.
Getting started
Our project stemmed from the wish to improve the implementation of technology in healthcare. The team consisted of myself, a foundation junior doctor with a knowledge of programming and an interest in Android app development; Michael Park, a professional software developer specialising in iPhone apps, who also has an understanding of medicine; and Andrew Seaton, a consultant in infectious diseases who (with the rest of the AUC) is responsible for developing and maintaining NHS GGC’s primary care antimicrobial guidelines.
What we did
We designed the free ‘GP Antibiotics’ app for Android and iPhone as a simple, searchable, pocket reference for the current NHS GGC primary care antimicrobial guidelines for the common infections encountered in adults and children. Doses, frequencies, durations of treatment, first-line, second-line and penicillin allergic options are included. The app took us 65 hours to develop and would have costed £3250 had we charged for it.
The app had to be high quality and user-friendly, designed for the needs of GPs on the go and not simply a collection of static pdf documents.
In addition, we designed our app to allow collection of anonymous usage data to help us improve the guidelines and the app. This feature can be disabled in the settings menu. We hope to use this data to help illuminate global usage of antibiotics and the relationship with resistance.
Once the prototype apps were completed, they were checked and peer reviewed by a number of lead primary care clinicians and pharmacists in the GGC AUC.
The ‘GP Antibiotics’ app was publicised through social media channels, via Sam and Michael’s website, and by an official GGC AUC letter to all GP practices and out of hours services.
Challenges
As ever, the rate-limiting factor is often cost. The STAR trial intervention cost £198,764 or £2,923 per practice. The TARGET team also launched an app – specific details of finance are not public but the whole project involved an application for funding from the board and contribution from individual GP practices.
But a lack of understanding of IT from healthcare professionals and vice versa often results in poor quality apps. A browse of the app stores reveals a number of failed attempts at healthcare apps – well-meaning HTML5 UK medical apps which have generated little interest with only 100-500 downloads over a year after launch.
In order to overcome these difficulties, our ‘GP Antibiotics’ app was created in our own free time and at no cost to NHS GGC whatsoever. No costly IT/healthcare consultation process was required as our team encompassed both these areas.
Results
Our initial usage figures show we had 976 active users (in 95 countries) within one week of the app’s release. In the UK, ‘GP Antibiotics’ entered the top 10 free iPhone medical apps and the top 100 free Android medical apps.
The future
We hope to continue to see rising adoption of the ‘GP Antibiotics’ app and for that to translate to improved compliance with primary care antibiotic guidelines. We plan to use the anonymous user engagement data to provide insights into global antibiotic guideline usage and antibiotic resistance patterns.
We would also like to see NHS GGC commission further apps for the plethora of essential information and guidelines currently hidden on our staff intranet, especially the in-patient antibiotic prescribing guidance.
We are encouraged by the increasing desire nationally to improve the implementation of technology in the NHS, evidenced by schemes like the NHS Hack Day.
Dr Sam Leighton is a junior doctor in Glasgow.
‘GP Antibiotic’ apps are available to download from the Google Play Store for Android and the Apple App Store for iPhone, or via polwarthlimited.com.
