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dc.contributor.authorKyaw, Bhone Myinten_US
dc.contributor.authorTudor Car, Lorainneen_US
dc.contributor.authorvan Galen, Louise Sandraen_US
dc.contributor.authorvan Agtmael, Michiel A.en_US
dc.contributor.authorCostelloe, Céire E.en_US
dc.contributor.authorAjuebor, Onyemaen_US
dc.contributor.authorCampbell, Jamesen_US
dc.contributor.authorCar, Josipen_US
dc.identifier.citationKyaw, B. M., Tudor Car, L., van Galen, L. S., van Agtmael, M. A., Costelloe, C. E., Ajuebor, O., . . . Car, J. (2019). Health professions digital education on antibiotic management : systematic review and meta-analysis by the Digital Health Education Collaboration. Journal of Medical Internet Research, 21(9), e14984-. doi:10.2196/14984en_US
dc.description.abstractBackground: Inappropriate antibiotic prescription is one of the key contributors to antibiotic resistance, which is managed with a range of interventions including education. Objective: We aimed to summarize evidence on the effectiveness of digital education of antibiotic management compared to traditional education for improving health care professionals’ knowledge, skills, attitudes, and clinical practice. Methods: Seven electronic databases and two trial registries were searched for randomized controlled trials (RCTs) and cluster RCTs published between January 1, 1990, and September 20, 2018. There were no language restrictions. We also searched the International Clinical Trials Registry Platform Search Portal and metaRegister of Controlled Trials to identify unpublished trials and checked the reference lists of included studies and relevant systematic reviews for study eligibility. We followed Cochrane methods to select studies, extract data, and appraise and synthesize eligible studies. We used random-effect models for the pooled analysis and assessed statistical heterogeneity by visual inspection of a forest plot and calculation of the I2 statistic. Results: Six cluster RCTs and two RCTs with 655 primary care practices, 1392 primary care physicians, and 485,632 patients were included. The interventions included personal digital assistants; short text messages; online digital education including emails and websites; and online blended education, which used a combination of online digital education and traditional education materials. The control groups received traditional education. Six studies assessed postintervention change in clinical practice. The majority of the studies (4/6) reported greater reduction in antibiotic prescription or dispensing rate with digital education than with traditional education. Two studies showed significant differences in postintervention knowledge scores in favor of mobile education over traditional education (standardized mean difference=1.09, 95% CI 0.90-1.28; I2=0%; large effect size; 491 participants [2 studies]). The findings for health care professionals’ attitudes and patient-related outcomes were mixed or inconclusive. Three studies found digital education to be more cost-effective than traditional education. None of the included studies reported on skills, satisfaction, or potential adverse effects. Conclusions: Findings from studies deploying mobile or online modalities of digital education on antibiotic management were complementary and found to be more cost-effective than traditional education in improving clinical practice and postintervention knowledge, particularly in postregistration settings. There is a lack of evidence on the effectiveness of other digital education modalities such as virtual reality or serious games. Future studies should also include health care professionals working in settings other than primary care and low- and middle-income countries.en_US
dc.relation.ispartofJournal of Medical Internet Researchen_US
dc.rights© 2019 Bhone Myint Kyaw, Lorainne Tudor Car, Louise Sandra van Galen, Michiel A van Agtmael, Céire E Costelloe, Onyema Ajuebor, James Campbell, Josip Car. Originally published in the Journal of Medical Internet Research ( This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.en_US
dc.titleHealth professions digital education on antibiotic management : systematic review and meta-analysis by the Digital Health Education Collaborationen_US
dc.typeJournal Articleen
dc.contributor.schoolLee Kong Chian School of Medicine (LKCMedicine)en_US
dc.contributor.organizationCentre for Population Health Sciencesen_US
dc.contributor.organizationFamily Medicine and Primary Careen_US
dc.description.versionPublished versionen_US
dc.subject.keywordsDigital Educationen_US
dc.subject.keywordsAntibiotic Managementen_US
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