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

Lucy Brookes-Howell; Emma Thomas-Jones; Janine Bates; Marie-Jet Bekkers; Curt Brugman; Elinor Coulman; Nick Francis; Khurram Hashmi; Kerenza Hood; Nigel Kirby; Carl Llor; Paul Little; Michael Moore; Anna Moragas; Kate Rumsby; Theo Verheij; Christopher Butler

doi:10.3399/bjgpopen18X101630

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

Lucy Brookes-Howell, Emma Thomas-Jones, Janine Bates, Marie-Jet Bekkers, Curt Brugman, Elinor Coulman, Nick Francis, Khurram Hashmi, Kerenza Hood, Nigel Kirby, Carl Llor, Paul Little, Michael Moore, Anna Moragas, Kate Rumsby, Theo Verheij, Christopher Butler

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

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.

Original language	English
Article number	18X101630
Number of pages	12
Journal	BJGP Open
Volume	3
Issue number	2
DOIs	https://doi.org/10.3399/bjgpopen18X101630
Publication status	Published - Jul 2019

Keywords

Antibiotics
Diagnosis
General practice
Point-of-care testing
Qualitative research
Urinary tract infections

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Brookes-Howell, L., Thomas-Jones, E., Bates, J., Bekkers, M.-J., Brugman, C., Coulman, E., Francis, N., Hashmi, K., Hood, K., Kirby, N., Llor, C., Little, P., Moore, M., Moragas, A., Rumsby, K., Verheij, T., & Butler, C. (2019). 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, 3(2), Article 18X101630. https://doi.org/10.3399/bjgpopen18X101630

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

abstract = "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.",

keywords = "Antibiotics, Diagnosis, General practice, Point-of-care testing, Qualitative research, Urinary tract infections",

author = "Lucy Brookes-Howell and Emma Thomas-Jones and Janine Bates and Marie-Jet Bekkers and Curt Brugman and Elinor Coulman and Nick Francis and Khurram Hashmi and Kerenza Hood and Nigel Kirby and Carl Llor and Paul Little and Michael Moore and Anna Moragas and Kate Rumsby and Theo Verheij and Christopher Butler",

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year = "2019",

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doi = "10.3399/bjgpopen18X101630",

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Brookes-Howell, L, Thomas-Jones, E, Bates, J, Bekkers, M-J, Brugman, C, Coulman, E, Francis, N, Hashmi, K, Hood, K, Kirby, N, Llor, C, Little, P, Moore, M, Moragas, A, Rumsby, K, Verheij, T & Butler, C 2019, '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, vol. 3, no. 2, 18X101630. https://doi.org/10.3399/bjgpopen18X101630

TY - JOUR

T1 - Challenges in managing urinary tract infection and the potential of a point-of-care test guided care in primary care

T2 - an international qualitative study

AU - Brookes-Howell, Lucy

AU - Thomas-Jones, Emma

AU - Bates, Janine

AU - Bekkers, Marie-Jet

AU - Brugman, Curt

AU - Coulman, Elinor

AU - Francis, Nick

AU - Hashmi, Khurram

AU - Hood, Kerenza

AU - Kirby, Nigel

AU - Llor, Carl

AU - Little, Paul

AU - Moore, Michael

AU - Moragas, Anna

AU - Rumsby, Kate

AU - Verheij, Theo

AU - Butler, Christopher

PY - 2019/7

Y1 - 2019/7

N2 - 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.

AB - 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.

KW - Antibiotics

KW - Diagnosis

KW - General practice

KW - Point-of-care testing

KW - Qualitative research

KW - Urinary tract infections

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U2 - 10.3399/bjgpopen18X101630

DO - 10.3399/bjgpopen18X101630

M3 - Article

C2 - 31366667

SN - 2398-3795

VL - 3

JO - BJGP Open

JF - BJGP Open

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ER -

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

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