Work Package 3

Evaluating the effectiveness of ePAMS+ in reducing antibiotic use in adult medical in-patients: a hybrid cluster-randomised stepped-wedge trial

Objectives

We seek to investigate the:

• Implementation of ePAMS+ and trial data collection processes using an internal pilot study
• Effectiveness of ePAMS+ in reducing total antibiotic consumption in adult medical in-patients (co-primary outcome)
• Non-inferiority of ePAMS+ for mortality in the 30 days from admission (co-primary outcome)
• Impact of ePAMS+ on the secondary clinical, safety and process outcome measures
• Mechanisms through which ePAMS+ exerts its effects and explore factors that may differentially influence the effectiveness of ePAMS+, drawing upon findings from the parallel longitudinal evaluation of the pilot and trial implementation of ePAMS+ (being undertaken in WP1)

Summary

We will focus on assessing whether ePAMS+ safely reduces the average total antibiotic consumption in adult medical in-patients as measured by DDD without any increase in 30-day mortality. Usual prescribing practice in study sites will be the comparator group. We will also assess the impact of ePAMS+ on the secondary clinical, safety and process outcome measures developed in WP2. Findings will be combined with the qualitative insights gained from WP1 to obtain a rich nuanced mixed-methods perspective on the effectiveness of ePAMS+ and implications for the generalisability and sustainability of deploying ePAMS+ more widely in NHS hospitals.

For further information contact Professor Christopher Weir (Christopher.Weir@ed.ac.uk)