Infection Control & Hospital Epidemiology
987
Fig. 1. Sessions of content accessed and unique users accessing the antibiotic app per month.
its original platform. Therefore, we hired a software development company (Ingenious Softworks, Montevideo, Uruguay) to develop the app on a new platform. In October 2016, physicians, advanced practice providers, pharmacists, and residents affiliated with Denver Health were notified of the availability of the upgraded app via the same methods used in 2014. We began to track utilization in December 2016. The study period began on January 1, 2017 and ended December 31, 2017.
Data Collection and Definitions
Google Analytics was used to extract data regarding use of the antibiotic app.12 This technology identifies the IP address of a device that is accessing a particular website. It can characterize the number and type of unique devices, the number of sessions, the mean session duration, and the frequency that certain content was accessed. From these data, we analyzed antibiotic app utili- zation on both a monthly and aggregate basis. “Sessions” were defined as the number of times a device
engaged with the app. “Unique devices” were the number of devices used to access app content. To control for providers who accessed the app from multiple devices, we estimated the number of “unique users” as the number of unique smartphones per time period.
Statistics
Linear regression models were performed to assess how app usage changed over time. Regression was performed for all device types combined as well as stratified by device type (ie, smartphone, desktop, and tablet). To assess model fit, P values and adjusted R2 values were examined. All statistics were performed using SAS version 9.4 software (SAS Institute, Cary NC). This study is non- human subjects research because no identifying data were collected.
Results
The antibiotic app was accessed 23,734 times on 5,097 unique devices during the study period. The mean session duration was 2:22 minutes. Overall usage increased by ~94 unique devices per
Discussion
Our institution-specific antibiotic app was utilized frequently in 2017, and its use grew over time. The increasing trend was seen
Table 1. Antibiotic App Utilization Patterns Metric
Unique devices Smartphone Desktop Tablet
Sessions
Smartphone Desktop Tablet
No. per Month, Range 477–853 293–468 183–478 2–11
1,495–2,457 1,257–1,953 229–685 3–17
aUsed to estimate the number of unique users of the antibiotic app.
month (P<.001) (Figure 1). Usage increased significantly on smartphone (P<.001) and desktop devices (P<.001), but not on tablets (P=.14). Adequate model fit was observed for the overall (Adj R2=0.829) and device-specific models (adj R2 [smart- phone]=0.679; adj R2 [desktop]=0.862) with the exception of the tablet-specific model (adj R2=0.127). While most unique devices were desktop computers (n=3151, 62.1%), most sessions were accessed from smartphones (n=18,860, 79.5%) (Table 1). Based on smartphone usage, we estimate that at least 1,887 unique users accessed the app in 2017. The most frequently accessed content included treatment of
urinary tract infections (UTIs) (336–688 sessions per month), respiratory tract infections (RTIs; 329–596 sessions per month), skin and soft-tissue infections (SSTIs; 289–615 sessions per month), gastrointestinal infections (108–195 sessions per month), and genital infections (52–153 sessions per month).
No. per Year (%) 5,072
1,887a (37.2) 3,151 (62.1) 39 (0.8) 23,734
18,860 (79.5) 4,761 (20.1) 113 (0.5)
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