Determinants of the successful adoption of a Computerised Antimicrobial Stewardship Program

Objectives: Clinical computing applications play a significant role in implementing antimicrobial stewardship programs. Little is known about the determinants of successful implementation of computerized antimicrobial stewardship program. The objective of this study was to identify perceived factors responsible for clinicians’ acceptance of a Computerised Antimicrobial Stewardship Program (CASP) and to determine the relationship between such factors and the actual use of the program by the junior doctors.

Methods: CASP was a decision support program that delivers evidence base guidelines, tailored to individual patient characteristics, to the junior doctors at the time of antimicrobial prescribing. A survey tool including demographic items and four scales to measured doctors’ perceptions of ease of use, usefulness, barriers and facilitators to use CASP was developed. Cross-sectional surveys were carried out over two consecutive years after the implementation of the program. Individual doctor’s automated usage report was used to measure their use of the CASP. Exploratory Factor Analysis (EFA) was used to extract various perceived factors from the survey results. Multiple linear regression was used to identify the predictability of perceived factors in determining the actual use of the CASP by the junior doctors. An alpha of 0.05 was used to determine the statistical significance and SPSS® Version 15.0 was used for the statistical analysis.

Results: A total of 142 doctors submitted complete responses for perceived ease of use and usefulness scales whereas 146 doctors responded to perceived barriers and facilitators scale to use CASP. All four scales showed good reliability with reliability co-efficient ranging from Cronbach’s alpha of 0.79-0.89 (values of 0.6 and above considered reliable). EFA identified a total of 10 specific factors from the 4 scales of perceived ease of use, usefulness, barriers and facilitators to doctors’ use of the CASP. Stepwise forward regression analysis of the identified factors provided a 5 variable solution. Perceived ease of use, disagreement with the computer program’s recommendations, lack of familiarity with the program, lack of clinical benefit from the program and lack of technical facilities (Beta= 0.368, p= 0.018) were found to determine the actual use of the CASP by the doctors.

Conclusion: All four scales used to measure the doctors’ perception of CASP were found to be reliable and valid. Positive doctors’ perceptions were found to be strongly associated with their actual use of the CASP. Furthermore, surveys provided useful information to improve CASP and its implementation at the studied hospital. Measuring doctors’ perceptions can provide useful information to improve antimicrobial stewardship programs.