App-based training module on guiding physicians’ prescription for antibiotic treatment of gonorrhoea in China: a pilot cluster-randomised controlled trial (Preprint)

BACKGROUND High prevalence of physicians’ non-adherence to treatment recommendations for gonorrhoea is a concern in China and poor awareness of treatment recommendations has been documented as one of reasons for the non-adherence. OBJECTIVE To assess the impact of an App-based training tool on improvement of adherence to treatment recommendations for gonorrhoea in China. METHODS We did a cluster-randomised controlled trial. Clusters were hospitals from four provinces in China. We randomly allocated each hospital to receive an App-based training module (ATM) or continue the routine of training (ROT). In ATM hospitals, physicians were offered a free App-based training through their smartphones for access to the training anytime (intervention) for 6 months. In ROT hospitals, physicians participated in any training programmes as they routinely did (control). The primary outcome was comparison of changes in adherence rate between ATM and ROT. The secondary outcome was reasons for physicians to explain their non-adherence. RESULTS Among 72 hospitals from the 4 provinces (18 hospitals of each province), 36 each received ATM and ROT, respectively. Over 6 months, the adherence rate increased from 53.6% to 54.8% in ATM group while the rate decreased from 43.9% to 42.5% in ROT. The difference (5.5%, 95% CI -7-18, P=0.37) in changes of the adherence rate between ATM and ROT was not statistically significant (risk ratio 1.12, 95% CI 0.93- 1.35, P=0.23). A major reason for physicians’ non-adherence to the treatment recommendations was a concern on adequacy of the recommended dosage of currently available generic format of ceftriaxone for treatment of gonorrhoea in China. CONCLUSIONS The findings indicate that sizeable improvement of adherence to the treatment recommendations through an App-based training tool might not be achievable over a 6-month period if concern on effectiveness of generic medicine still exits. CLINICALTRIAL https://www.chictr.org.cn/ ChiCTR2000029591 INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2020-037549