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Primary Health Care for ChildrenmedAL-mentorNCT05901155

Impact of a Real-time Mentoring Tool on Antibiotic Prescription (medAL-mentor)

A study testing MedAL-mentor in people with Primary Health Care for Children, run by Center for Primary Care and Public Health (Unisante), University of Lausanne, Switzerland at 40 sites in Tanzania.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The goal of this ancillary study, part of the DYNAMIC project, is to reduce antibiotic prescription and improve the quality of care for children in primary care in Tanzania using a near real-time mentoring tool (called medAL-mentor), based on a monitoring and benchmarking dashboard and feedback by the monitoring team. Read more about this study

Who is it for?
Ages 1 day to 14 years
Conditions the study is for
Primary Health Care for Children
What is being tested?
MedAL-mentor
Could I receive a placebo?
No, everyone receives an active treatment
How many people
37,000 participants
Where
40 sitesTanzania
Study dates
5 Jun 2023to 30 Dec 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 day to 14 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Presenting for an acute medical or surgical condition

Who cannot join

  • Presenting for scheduled consultation for a chronic disease (e.g. HIV, tuberculosis, non-communicable diseases, malnutrition)
  • Presenting for routine preventive care (e.g. growth monitoring, vitamin supplementation, deworming, vaccination)

Trial locations and contacts

40 sites in 1 country.

40 sites in 1 country

Tanzania40 sites
  • Chikuti Dispensary

    Chikuti, Morogoro

  • Chirombora Dispensary

    Chirombora, Morogoro

  • Chita Rural Dispensary

    Chita, Morogoro

  • Idete Dispensary

    Idete, Morogoro

  • Idiga Dispensary

    Idiga, Mbeya

  • Idunda Dispensary

    Idunda, Morogoro

  • Kibaoni Health Center

    Ifakara, Morogoro

  • Michenga Dispensary

    Ifakara, Morogoro

  • Sagamaganga Dispensary

    Ifakara, Morogoro

  • Igoma Dispensary

    Igoma, Mbeya

  • Lwanjilo Dispensary

    Ilowelo, Mbeya

  • Inyala Health Center

    Inyala, Mbeya

  • Iwindi Dispensary

    Iwindi, Mbeya

  • Ketaketa Dispensary

    Kataketa, Morogoro

  • Kichangani Dispensary

    Kichangani, Morogoro

  • Kimondo Dispensary

    Kimondo, Mbeya

  • Kisegese Dispensary

    Kisegese, Morogoro

  • Mbalizi Dispensary

    Mbalizi, Mbeya

  • Isyesye Dispensary

    Mbeya

  • Itagano Dispensary

    Mbeya

  • Itensa Dispensary

    Mbeya

  • Itezi Dispensary

    Mbeya

  • Itijy Dispensary

    Mbeya

  • Iyunga Health Center

    Mbeya

  • Ndanyela Dispensary

    Mbeya

  • Nzovwe Health Center

    Mbeya

  • Tembela Dispensary

    Mbeya

  • Mbuga Dispensary

    Mbuga, Morogoro

  • Milola Dispensary

    Milola, Morogoro

  • Mjele Dispensary

    Mjele, Mbeya

  • Mshewe Dispensary

    Mjele, Mbeya

  • Mngeta Health Center

    Mngeta, Morogoro

  • Mwabwowo Dispensary

    Mwabwowo, Mbeya

  • Santilya Health Center

    Santilya, Mbeya

  • Shuwa Dispensary

    Shuwa, Mbeya

  • Songwe viwandani Dispensary

    Songwe, Mbeya

  • Sanje Dispensary

    Sonjo, Morogoro

  • Sonjo Dispensary

    Sonjo, Morogoro

  • Udagaji Dispensary

    Udagaji, Morogoro

  • Utengule Dispensary

    Utengule, Morogoro

Other trials in Tanzania

About this study

Official title: Impact of medAL-mentor, a Real-time Mentoring and Benchmarking Tool, on Antibiotic Prescription Among Children in Primary Health Care Facilities in Tanzania

The goal of this ancillary study, part of the DYNAMIC project, is to reduce antibiotic prescription and improve the quality of care for children in primary care in Tanzania using a near real-time mentoring tool (called medAL-mentor), based on a monitoring and benchmarking dashboard and feedback by the monitoring team. The main question to be answered is: Can real-time mentoring, based on clinical decision support algorithm data, improve healthcare workers' compliance with guidelines - and therefore quality of care for paediatric outpatients? Health providers in participating health facilities will receive either the medAL-mentor tool and feedback from the monitoring team (intervention group), or standard mentoring (control group), so that the impact on antibiotic prescription and other quality of care indicators can be compared between the two arms.

Read the detailed description

ePOCT+ is a paediatric digital clinical decision support algorithm for health workers in primary care facilities in Tanzania. The objective is to improve the integrated management of acutely ill children aged 1 day to 14 years and reduce inappropriate antibiotic prescriptions.

Preliminary findings from the first phase of the DYNAMIC project, an open-label cluster randomized controlled study performed in 40 health facilities, showed a reduction in antibiotic prescription by health providers from about 70% in the control arm to 23% in health facilities using ePOCT+, with similar clinical outcomes in children at day 7. Nevertheless, uptake of ePOCT+ and antibiotic prescription in the intervention arm were very heterogeneous across health facilities.

Benchmarking in healthcare is defined as "a process of comparative evaluation and identification of the underlying causes leading to high levels of performance". The findings and experiences of different institutions are shared, and elements of best practices are adopted to improve performance. Benchmarking has been promoted for years by infectious diseases societies as a component of hospital antimicrobial stewardship programs, to reduce antibiotic prescription. Benchmarking has also been shown to be an effective incentive to improve the quality of care in various settings, including primary care practice. Unfortunately, published initiatives have largely come from high-income countries.

In the context of the DYNAMIC project, we developed a near real-time mentoring tool, medAL-mentor, based on a monitoring and benchmarking dashboard using data collected through ePOCT+. The tool provides direct feedback to health workers on their performance, based on several clinical indicators (including antibiotic prescription), in comparison with data from other health facilities. The monitoring team will target calls and monitoring visits to health facilities based on these indicators and use the dashboard to facilitate discussions with healthcare workers.

This ancillary study, MedAL-mentor, aims to assess whether this real-time mentoring tool based on data generated by a clinical decision support algorithm, as well as feedback from the mentoring team, improves healthcare workers' compliance with guidelines - and therefore the quality of care for sick children at primary care level.

More specifically, the study objectives are :

Primary objective :

To determine whether the provision of medAL-mentor, a digital mentoring tool, decreases antibiotic prescription by primary care clinicians using a clinical decision support algorithm (ePOCT+) for the management of sick children

Secondary objectives are :

  1. To assess the impact of medAL-mentor on clinicians' uptake of ePOCT+
  2. To assess the impact of medal-mentor on clinicians in terms of :
  3. Performance of key measurements and assessment of signs by clinicians
  4. Compliance with the recommendations related to point-of-care tests (for malaria and haemoglobin)

This open-label, parallel cluster randomized controlled study is embedded in the second phase of the DYNAMIC project in Tanzania. The intervention consists of providing direct access to medAL-mentor to the healthcare workers. The mentoring team will target calls and monitoring visits to health facilities based on medAL-mentor indicators and use the dashboard to facilitate discussions with healthcare workers during the monitoring visits. Since the intervention takes place at the healthcare worker level and their practices are influenced by the context of the health facility they are working in, randomization at the health facility level rather than at the health worker level was chosen.

40 health facilities using ePOCT+ for the first time during the second phase of the DYNAMIC project will be randomly selected and assigned to two groups (randomization 1:1, intervention: control). Health workers in health facilities randomized to the intervention group will receive feedback on their performance through direct access to medAL-mentor and regular mobile messages, as well as targeted phone calls and visits by the monitoring team based on the medAL-mentor dashboard. Health facilities from the control group will receive standard monitoring (regular messages to check for any issues and regular site visits), without access to medAL-mentor (neither for the health workers nor for the monitoring team).

Being tested
MedAL-mentor
Keywords
Digital health, Antibiotic stewardship, Real-time mentoring, Benchmarking, Clinical decision support algorithm

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • MedAL-mentorDevice

    MedAL-mentor is a near real-time monitoring and benchmarking dashboard based on data collected through ePOCT+, providing direct feedback on several clinical indicators (antibiotic prescription, performance of key measurements, signs, and diagnostic tests).

Study groups in NCT05901155
Study groupRoleWhat they receive
MedAL-mentorExperimentalIn health facilities allocated to the medAL-mentor arm, the intervention will consist in : * Providing tablets with ePOCT+ and initial training for use by healthcare workers * Access to medAL-mentor for healthcare workers and the monitoring team * Regular (at least every 2 weeks) supportive messages sent by the monitoring team to healthcare workers providing feedback from medAL-mentor * Targeted phone calls and health facilities visits by the monitoring team based on medAL-mentor review Monitoring will be performed by the study team.
Receives: Device: MedAL-mentor
Routine mentoringNo interventionIn health facilities allocated to the control arm, tablets with ePOCT+ will also be provided to healthcare workers with initial training, but subsequent mentoring will be conducted routinely: * No access to medAL-mentor for healthcare workers or the monitoring team * At least one message sent by the monitoring team to healthcare workers every two weeks, to inquire about any issues and trigger a site visit if needed * At least one visit from the monitoring team in each health facility every two months Monitoring will be performed by the study team.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percentage of children prescribed an antibiotic in the intervention group (medAL-mentor) as compared to the control group (routine mentoring)

    Number of children for whom at least one systemic (oral or parenteral) antibiotic has been prescribed during consultation, over all eligible children, as reported by the healthcare workers in a routine registry

    Measured: Day 0 (by the end of the consultation)

Secondary outcomes (3)
  1. Percentage of consultations with eligible children performed using ePOCT+

    Number of consultations completed with ePOCT+, over all consultations with eligible children as reported in a routine registry

    Measured: Day 0 (by the end of the consultation)

  2. Percentage of children in whom key signs have been checked by healthcare workers

    Number of children in whom key signs (temperature, weight, mid-upper arm circumference (MUAC), respiratory rate) have been checked by healthcare workers, over the total number of children for whom this was recommended, as reported by healthcare workers in ePOCT+

    Measured: Day 0 (by the end of the consultation)

  3. Percentage of children for whom appropriate diagnostic tests have been performed by healthcare workers

    Number of children for whom diagnostic tests (haemoglobin and malaria tests) have been performed by healthcare workers, over the total number of children for whom diagnostic tests were recommended, as reported by healthcare workers in ePOCT+

    Measured: Day 0 (by the end of the consultation)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Jun 2023
  2. Study start5 Jun 2023
  3. Primary completion30 Nov 2023
  4. Study completion30 Dec 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Randomised
Intervention model
Parallel groups
Model description
The study involves two arms: intervention and control. Health facilities will serve as clusters, with half of the facilities (20) receiving the intervention and the other half serving as controls (20). Health facilities will be randomized to their respective study arm. A parallel design (all health facilities start at the same time) will be used.
Masking
None (open label)
Enrolment
37,000 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05901155
Sponsor's protocol ID
2020-02800_substudymedalmentor
Acronym
medAL-mentor
Status last verified
Dec 2023
First submitted
11 May 2023
Last updated
17 Jan 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Ellis J. All inclusive benchmarking. J Nurs Manag. 2006 Jul;14(5):377-83. doi: 10.1111/j.1365-2934.2006.00596.x.

    PubMed 16787472
  • Thonon F, Watson J, Saghatchian M. Benchmarking facilities providing care: An international overview of initiatives. SAGE Open Med. 2015 Sep 23;3:2050312115601692. doi: 10.1177/2050312115601692. eCollection 2015.

    PubMed 26770800
  • Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, Huskins WC, Paterson DL, Fishman NO, Carpenter CF, Brennan PJ, Billeter M, Hooton TM; Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007 Jan 15;44(2):159-77. doi: 10.1086/510393. Epub 2006 Dec 13. No abstract available.

    PubMed 17173212
  • Willmington C, Belardi P, Murante AM, Vainieri M. The contribution of benchmarking to quality improvement in healthcare. A systematic literature review. BMC Health Serv Res. 2022 Feb 2;22(1):139. doi: 10.1186/s12913-022-07467-8.

    PubMed 35109824
  • Piccoliori G, Mahlknecht A, Abuzahra ME, Engl A, Breitenberger V, Vogele A, Montalbano C, Sonnichsen A. Quality improvement in chronic care by self-audit, benchmarking and networking in general practices in South Tyrol, Italy: results from an interventional study. Fam Pract. 2021 Jun 17;38(3):253-258. doi: 10.1093/fampra/cmaa123.

    PubMed 33184661
  • Hermans MP, Elisaf M, Michel G, Muls E, Nobels F, Vandenberghe H, Brotons C; OPTIMISE International Steering Committee. Benchmarking is associated with improved quality of care in type 2 diabetes: the OPTIMISE randomized, controlled trial. Diabetes Care. 2013 Nov;36(11):3388-95. doi: 10.2337/dc12-1853. Epub 2013 Jul 11.

    PubMed 23846810
  • Meeker D, Linder JA, Fox CR, Friedberg MW, Persell SD, Goldstein NJ, Knight TK, Hay JW, Doctor JN. Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial. JAMA. 2016 Feb 9;315(6):562-70. doi: 10.1001/jama.2016.0275.

    PubMed 26864410

Questions about this trial

What is this clinical trial studying?

A study testing MedAL-mentor in people with Primary Health Care for Children, run by Center for Primary Care and Public Health (Unisante), University of Lausanne, Switzerland at 40 sites in Tanzania.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 17 Jan 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 40 sites in Tanzania. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percentage of children prescribed an antibiotic in the intervention group (medAL-mentor) as compared to the control group (routine mentoring) (time frame: Day 0 (by the end of the consultation)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05901155, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Jan 2024.

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