Workload, diagnostic work-up and treatment of urinary tract infections in adults during out-of-hours primary care: a retrospective cohort study
| Autor: | Guy J. Oudhuis, Jochen W L Cals, Paul H. M. Savelkoul, Michelle Spek, Eefje G. P. M. de Bont |
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| Přispěvatelé: | Family Medicine, RS: CAPHRI - R5 - Optimising Patient Care, Medische Microbiologie, MUMC+: DA MMI Staf (9), MUMC+: DA Medische Microbiologie en Infectieziekten (5), RS: CAPHRI - R4 - Health Inequities and Societal Participation |
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty SYMPTOMS medicine.drug_class Urinary system Antibiotics Workload urologic and male genital diseases Out-of-hours primary care 03 medical and health sciences MICTURITION PROBLEMS 0302 clinical medicine After-Hours Care Cultures Internal medicine GENERAL-PRACTICE Humans Medicine 030212 general & internal medicine Medical prescription Retrospective Studies lcsh:R5-920 030505 public health Primary Health Care business.industry Retrospective cohort study Urinary tract infections Work-up Anti-Bacterial Agents Nitrite test ESCHERICHIA-COLI Female lcsh:Medicine (General) General practice 0305 other medical science Family Practice business Research Article Cohort study |
| Zdroj: | BMC Family Practice, 21(1):231. BioMed Central Ltd BMC Family Practice, Vol 21, Iss 1, Pp 1-7 (2020) BMC Family Practice |
| ISSN: | 1471-2296 |
| Popis: | Background Urinary tract infections (UTIs) are one of the most common infections in primary care. Previous research showed that GPs find it challenging to diagnose UTIs and frequently divert from guidelines leading to unwarranted antibiotic prescriptions and inefficient use of diagnostics such as urinary cultures. We hypothesise that management of UTIs during out-of-hours care may be extra challenging due to a higher workload and logistical issues regarding diagnostic work-up and obtaining results. We therefore aimed to study the workload, diagnostic work-up and treatment of UTIs during out-of-hours primary care. Methods We performed a retrospective observational cohort study in which we analysed a full year (2018) of electronic patient records of two large Dutch GP out-of-hours centres. All adult patients with UTI symptoms were included in this study. Descriptive statistics and multivariate regression were used to analyse diagnostics and subsequent management. Results A total of 5657 patients were included (78.9% female, mean age of 54 years), with an average of eight patients per day that contact a GP out-of-hours centre because of UTI symptoms. Urinary dipsticks were used in 87.5% of all patients visiting the out-of-hours centres with UTI symptoms. Strikingly, urinary cultures were only requested in 10.3% of patients in which urinary culture was indicated. Seventy-four percent of the patients received antibiotics. Seventy-nine percent of the patients with a negative nitrite test still received antibiotics. Remarkably, patients at risk of complications because of a UTI, such as men, received fewer antibiotic prescriptions. Conclusions In total, 74% of the patients received antibiotics. 8 out of 10 patients still received an antibiotic prescription in case of a negative nitrite test, and 9 out of 10 patients with an indication did not receive a urine culture. In conclusion, we found that correctly diagnosing UTIs and prescribing antibiotics for UTIs is a challenge that needs major improvement, especially during out-of-hours GP care. |
| Databáze: | OpenAIRE |
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