Jones Leah Ffion, Cooper Emily, Joseph Amelia, Allison Rosalie, Gold Natalie, Donald Ian, McNulty Cliodna
Public Health England, Primary Care Interventions Unit, Gloucester, UK.
Nottingham University Hospital, Nottingham, UK.
BJGP Open. 2020 Aug 25;4(3). doi: 10.3399/bjgpopen20X101044. Print 2020 Aug.
Urinary tract infections (UTIs), older age, lack of access to health care, and recent antibiotic use are risk factors for () bloodstream infections.
To explore the diagnosis and management of UTIs in primary care to inform the development of an information leaflet, a diagnostic flow chart, and recommendations for other resources.
DESIGN & SETTING: The study had a qualitative design and was undertaken in primary care settings and care homes.
Interviews and focus groups were informed by the Theoretical Domains Framework (TDF) with 31 care home staff, three residents, six relatives, 57 GP staff, and 19 members of the public. An inductive thematic analysis was used and themes were placed in the Behaviour Change Wheel (BCW) to recommend interventions.
Care home staff were pivotal for identifying suspected UTI, alerted clinicians to symptoms that influenced prescribing decisions, and reported confusion or behavioural changes as the most common diagnostic sign. Care home staff lacked knowledge about asymptomatic bacteriuria (ASB) and sepsis, and incorrectly diagnosed UTI using urine dipsticks. GP staff used urine dipsticks to rule out UTI and reported that stopping dipsticks would require a culture change, clear protocols, and education about ASB. Many prescribers believed that stopping urine dipstick use should help to reduce antibiotic use.
A consistent message about ASB and UTI diagnosis and management in older adults should be communicated across the care pathway. Resource development should increase capability, motivation, and opportunity to improve management of suspected UTIs. An educational leaflet for older adults and a diagnostic flow chart for clinicians have been developed, and recommendations for interventions are discussed.
尿路感染（UTIs）、老年、缺乏医疗保健服务以及近期使用抗生素是发生（）血流感染的危险因素。
探讨初级保健中尿路感染的诊断和管理，为编写信息手册、诊断流程图及其他资源建议提供依据。
本研究采用定性设计，在初级保健机构和养老院开展。
采用理论领域框架（TDF）对31名养老院工作人员、3名居民、6名亲属、57名全科医生工作人员和19名公众进行访谈和焦点小组讨论。采用归纳主题分析法，并将主题纳入行为改变轮（BCW）以推荐干预措施。
养老院工作人员对于识别疑似尿路感染至关重要，能提醒临床医生注意影响处方决策的症状，并报告意识模糊或行为改变是最常见的诊断体征。养老院工作人员缺乏关于无症状菌尿（ASB）和败血症的知识，使用尿试纸错误诊断尿路感染。全科医生工作人员使用尿试纸排除尿路感染，并报告停止使用尿试纸需要改变观念、明确方案以及开展关于ASB的教育。许多开处方者认为停止使用尿试纸应有助于减少抗生素使用。
应在整个护理路径中传达关于老年人ASB和尿路感染诊断及管理的一致信息。资源开发应提高识别疑似尿路感染的能力、积极性和机会。已为老年人编写了一份教育手册，并为临床医生制定了一份诊断流程图，同时讨论了干预建议。
