mHealth Apps Available in Italy to Support Health Care Professionals in Antimicrobial Stewardship Implementation: Systematic Search in App Stores and Content Analysis

Abstract

Background: Antimicrobial resistance (AMR) is a major challenge of the 21st century. Digital technologies are now an increasingly effective means of supporting optimal health care delivery and public health.

Objective: The aim of this study was to explore the apps available to support health care professionals in the fight against AMR.

Methods: A total of 4 independent researchers conducted a systematic search of the App Store and Google Play Store using the following keywords: "antimicrobial resistance," "antibiotic resistance," "antimicrobial stewardship," "antibiotic stewardship," "antibiotic guide," "antibiotic therapy," and "antimicrobial therapy." The same keywords were also searched in Italian. The apps whose contents were in languages other than Italian or English, or apps which were games, or had multimedia or paid content and advertising, or apps for only specific pathologies were not considered. A set of basic information was collected for all apps found. After downloading the apps, they were evaluated using an 86-item checklist containing expert-validated criteria aggregated in the domains of pathogens and etiological agents, diagnosis and therapy support, AMR, dashboard function, antimicrobial stewardship (AMS), notes and recordings, network, and technical characteristics of the app.

Results: First, 115 apps were identified: 31 apps for Android and 84 apps for iOS. By applying the exclusion criteria, 31 apps were excluded (16 for Android and 15 for iOS) for the following reasons: not available in Italian or English (6 apps), not freely available (14 apps), required registration (5 apps), and games (6 apps). The remaining 84 eligible apps (15 for Android and 69 for iOS) were downloaded, installed, and further analyzed using the same criteria, excluding 57 apps (48 for iOS and 9 for Android) for the following reasons: required further registration (16 apps), language other than Italian or English (17 apps), pathology specific (5 apps), paid content (8 apps), specific to veterinarians (4 apps), recreational apps (2 apps), referred to only scientific articles (1 app), no longer available (1 app), and not health care objectives (3 apps). The remaining 27 apps (6 for Android and 21 for iOS) were selected for in-depth analysis. Of the 27 apps that met the inclusion criteria, most apps did not fulfill the desirable aspects and only 2 of them achieved a fulfillment score of 36%. The highest scores were achieved for support for diagnosis and therapy (37%) and technical characteristics of the app (23%). Lower scores were achieved for AMS (8%), pathogens and etiological agents (4%), notes and records (3%), network (2%), AMR (1%), and dashboard function (1%).

Conclusions: None of the apps examined successfully provided the desired features and functions. To better engage of prescribers in the fight against AMR, the development of an app that meets the requirements is needed.

Keywords: Italy; antimicrobial; antimicrobial resistance; antimicrobial stewardship; app; application; diagnosis; engagement; mHealth; mobile health; one health; prescribing behaviors; support; therapy support.

Figure 1.. Results of the app selection process.