Why are we misdiagnosing urinary tract infection in older patients? A qualitative inquiry and roadmap for staff behaviour change in the emergency department.

Autor: O'Kelly K; Geriatric Medicine, University Hospitals of Leicester, Leicester, UK., Phelps K; Department of Health Sciences, George Davies Centre, University of Leicester, Room 3.37, University Road, Leicester, LE1 7RH, UK., Regen EL; Department of Health Sciences, George Davies Centre, University of Leicester, Room 3.37, University Road, Leicester, LE1 7RH, UK., Carvalho F; Loughborough Design School, Loughborough University, Loughborough, UK., Kondova D; Geriatric Medicine, University Hospitals of Leicester, Leicester, UK., Mitchell V; Loughborough Design School, Loughborough University, Loughborough, UK., Conroy SP; Department of Health Sciences, George Davies Centre, University of Leicester, Room 3.37, University Road, Leicester, LE1 7RH, UK. spc3@le.ac.uk., Jun GT; Loughborough Design School, Loughborough University, Loughborough, UK.
Jazyk: angličtina
Zdroj: European geriatric medicine [Eur Geriatr Med] 2019 Aug; Vol. 10 (4), pp. 585-593. Date of Electronic Publication: 2019 Apr 16.
DOI: 10.1007/s41999-019-00191-3
Abstrakt: Purpose: The aim of this study was to identify the psychological and behavioural factors influencing clinicians managing older people with possible UTI in urgent care settings, and to develop an improvement roadmap.
Methods: Michie's behaviour change wheel and COM-B (Capability, Opportunity, Motivation, Behaviour Change) models were used as the theoretical basis for this study. Semi-structured interviews were undertaken with 21 purposively selected medical and nursing staff in a large urban emergency department in the East Midlands, United Kingdom. Analysis was informed by the framework approach. A participatory design approach was used to develop an improvement roadmap.
Results: Key themes emerging from the semi-structured interviews included lack of knowledge on the role of urine dipstick testing, bias towards older people, automatic testing, time and resource constraints, pressures from peers and patients, and fear of the legal consequences of inaction. A thematic networks map indicated complex interactions between psychological and behavioural factors. Among more than 50 different intervention ideas identified by the workshop participants, two interventions were prioritised for implementation: i) controlling the use of dip stick urine tests; ii) providing individualised feedback to staff regarding the outcomes of patients diagnosed and treated for UTI.
Conclusions: Psychological and behavioural factors play a significant role in the misdiagnosis of UTI in older people. Systematic approaches incorporating these factors might improve patient outcomes. Future studies should focus on implementation and evaluating their effectiveness and sustainability.
(© 2019. European Geriatric Medicine Society.)
Databáze: MEDLINE
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