Challenges in managing urinary tract infection and the potential of a point-of-care test guided care in primary care: an international qualitative study

BJGP Open

Nigel Kirby¹  Janine Bates¹  Emma Thomas-Jones¹  Kerenza Hood¹  Elinor Coulman¹  Lucy Brookes-Howell¹  Marie-Jet Bekkers¹  Nick Francis²  Khurram Hashmi³  Carl Llor³  Curt Brugman⁴  Theo Verheij⁴  Christopher Butler⁵  Paul Little⁶  Michael Moore⁶  Kate Rumsby⁶  Anna Moragas⁷ 

[1] Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK;Division of Population Medicine, Cardiff University, Cardiff, UK;Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK;Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands;Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK;Primary Care & Population Sciences, University of Southampton, Southampton, UK;University Institute in Primary Care Research Jordi Gol, Via Roma Health Centre, Barcelona, Spain;

关键词: general practice;    point-of-care testing;    urinary tract infections;    diagnosis;    qualitative research;    antibiotics;   

DOI  :  10.3399/bjgpopen18X101630

来源: DOAJ

【 摘 要 】

Background: Little is known about clinicians’ experiences of using a point-of-care test (POCT) to inform management of urinary tract infection (UTI) in general practice. Aim: To explore experiences of using the Flexicult test to inform management of UTI and views on requirements for an optimal POCT to inform successful implementation. Design & setting: Telephone interviews with 35 primary care clinicians and healthcare professionals in Wales, England, Spain, and the Netherlands, who had participated in a trial of the Flexicult POCT for UTI based on urine culture. Method: Thematic analysis of semi-structured interviews. Results: Most primary care clinicians interviewed agreed on the need for a POCT in UTI management, and that the Flexicult POCT delivered quicker results than laboratory results used in usual care, reassured patients, boosted their confidence in decision-making, and reminded them about antibiotic stewardship. However, clinicians also reported difficulties in interpreting results, limitations on when the Flexicult could be used, and concerns that testing all patients would strain care delivery and prolong patient discomfort when delaying decisions until a non-rapid POCT result was available. An optimal POCT would produce more rapid results, and be reliable and easy to use. Uptake into routine care would be enhanced by: clear guidance on which patients should be tested; training for interpreting ‘grey area’ results; reiterating that even ‘straightforward’ cases might be better managed with a test; clear messages about stopping unnecessary antibiotics versus completing a course; and better self-management strategies to accompany implementation of delayed, or non-prescription of, antibiotics. Conclusion: Primary care clinicians believe that POCT tests could play a useful role in the management of UTI and gave clear recommendations for successful implementation.

【 授权许可】

Unknown