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

Challenges in managing urinary tract infection and the potential of a point-of-care test guided care in primary care: an international qualitative study
Challenges in managing urinary tract infection and the potential of a point-of-care test guided care in primary care: an international qualitative study
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.
0960-1643
Brookes-Howell, Lucy
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Thomas-Jones, Emma
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Bates, Janine
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Bekkers, Marie-Jet
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Brugman, Curt
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Coulman, Elinor
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Francis, Nick A.
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Hashmi, Khurram
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Hood, Kerenza
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Kirby, Nigel
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Llor, Carl
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Little, Paul
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Moore, Michael
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Moragas, Anna
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Rumsby, Kate
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Verheij, Theo
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Butler, Christopher C.
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Brookes-Howell, Lucy
307c5275-082d-4586-ba9d-461527607164
Thomas-Jones, Emma
ea15d5ac-8232-4823-ab40-17bec0968520
Bates, Janine
290a69e6-4f81-4dbe-b270-30e4155ca576
Bekkers, Marie-Jet
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Brugman, Curt
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Coulman, Elinor
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Francis, Nick A.
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Hashmi, Khurram
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Hood, Kerenza
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Kirby, Nigel
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Llor, Carl
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Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Moore, Michael
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Moragas, Anna
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Rumsby, Kate
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Verheij, Theo
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Butler, Christopher C.
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Brookes-Howell, Lucy, Thomas-Jones, Emma, Bates, Janine, Bekkers, Marie-Jet, Brugman, Curt, Coulman, Elinor, Francis, Nick A., Hashmi, Khurram, Hood, Kerenza, Kirby, Nigel, Llor, Carl, Little, Paul, Moore, Michael, Moragas, Anna, Rumsby, Kate, Verheij, Theo and Butler, Christopher 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. British Journal of General Practice. (doi:10.3399/bjgpopen18X101630).

Record type: Article

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.

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Accepted/In Press date: 26 October 2018
e-pub ahead of print date: 2 April 2019

Identifiers

Local EPrints ID: 430024
URI: https://eprints.soton.ac.uk/id/eprint/430024
ISSN: 0960-1643
PURE UUID: 92b9b82e-213b-45dc-9729-e9addbd11c84
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Kate Rumsby: ORCID iD orcid.org/0000-0002-8573-3718

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Date deposited: 10 Apr 2019 16:30
Last modified: 11 Apr 2019 00:37

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Contributors

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

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