"A false sense of confidence" The perceived role of inflammatory point-of-care testing in managing urinary tract infections in Dutch nursing homes: a qualitative study.
Implementation
Nursing home
Point-of-care test
Qualitative study
Urinary tract infection
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
04 11 2020
04 11 2020
Historique:
received:
17
06
2020
accepted:
26
10
2020
entrez:
5
11
2020
pubmed:
6
11
2020
medline:
14
1
2021
Statut:
epublish
Résumé
Diagnosing urinary tract infections (UTI) in nursing home residents is complex, due to frequent non-specific symptomatology and asymptomatic bacteriuria. The objective of this study was to explore health care professionals' perceptions of the proposed use of inflammatory marker Point-Of-Care Testing (POCT) in this respect. We conducted a qualitative inquiry (2018-2019) alongside the multicenter PROGRESS study (NL6293), which assessed the sensitivity of C-reactive protein and procalcitonin POCT in UTI. We used semi-structured face-to-face interviews. The participants were physicians (n = 12) and nurses (n = 6) from 13 nursing homes in the Netherlands. Most respondents were not familiar with inflammatory marker POCT, while some used POCT for respiratory tract infections. Both the interview guide and the analysis of the interview transcripts were based on the Consolidated Framework for Implementation Research. All respondents acknowledged that sufficiently sensitive POCT could decrease diagnostic uncertainty to some extent in residents presenting with non-specific symptoms. They primarily thought that negative test results would rule out UTI and justify withholding antibiotic treatment. Secondly, they described how positive test results could rule in UTI and justify antimicrobial treatment. However, most respondents also expected new diagnostic uncertainties to arise. Firstly, in case of negative test results, they were not sure how to deal with residents' persisting non-specific symptoms. Secondly, in case of positive test results, they feared overlooking infections other than UTI. These new uncertainties could lead to inappropriate antibiotics use. Therefore, POCT was thought to create a false sense of confidence. Our study suggests that inflammatory marker POCT will only improve UTI management in nursing homes to some extent. To realize the expected added value, any implementation of POCT requires thorough guidance to ensure appropriate use. Developing UTI markers with high negative and positive predictive values may offer greater potential to improve UTI management in nursing homes.
Sections du résumé
BACKGROUND
Diagnosing urinary tract infections (UTI) in nursing home residents is complex, due to frequent non-specific symptomatology and asymptomatic bacteriuria. The objective of this study was to explore health care professionals' perceptions of the proposed use of inflammatory marker Point-Of-Care Testing (POCT) in this respect.
METHODS
We conducted a qualitative inquiry (2018-2019) alongside the multicenter PROGRESS study (NL6293), which assessed the sensitivity of C-reactive protein and procalcitonin POCT in UTI. We used semi-structured face-to-face interviews. The participants were physicians (n = 12) and nurses (n = 6) from 13 nursing homes in the Netherlands. Most respondents were not familiar with inflammatory marker POCT, while some used POCT for respiratory tract infections. Both the interview guide and the analysis of the interview transcripts were based on the Consolidated Framework for Implementation Research.
RESULTS
All respondents acknowledged that sufficiently sensitive POCT could decrease diagnostic uncertainty to some extent in residents presenting with non-specific symptoms. They primarily thought that negative test results would rule out UTI and justify withholding antibiotic treatment. Secondly, they described how positive test results could rule in UTI and justify antimicrobial treatment. However, most respondents also expected new diagnostic uncertainties to arise. Firstly, in case of negative test results, they were not sure how to deal with residents' persisting non-specific symptoms. Secondly, in case of positive test results, they feared overlooking infections other than UTI. These new uncertainties could lead to inappropriate antibiotics use. Therefore, POCT was thought to create a false sense of confidence.
CONCLUSIONS
Our study suggests that inflammatory marker POCT will only improve UTI management in nursing homes to some extent. To realize the expected added value, any implementation of POCT requires thorough guidance to ensure appropriate use. Developing UTI markers with high negative and positive predictive values may offer greater potential to improve UTI management in nursing homes.
Identifiants
pubmed: 33148189
doi: 10.1186/s12877-020-01853-9
pii: 10.1186/s12877-020-01853-9
pmc: PMC7643302
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
450Subventions
Organisme : ZonMw
ID : 541001003
Pays : Netherlands
Références
BMJ Open. 2019 Aug 10;9(8):e031269
pubmed: 31401614
NPJ Prim Care Respir Med. 2014 Jul 17;24:14026
pubmed: 25030621
Aging health. 2013 Oct;9(5):
pubmed: 24391677
Br J Gen Pract. 2009 Apr;59(561):e93-100
pubmed: 19341544
Implement Sci. 2008 Jul 16;3:36
pubmed: 18631386
Clin Microbiol Infect. 2019 Jul;25(7):779-781
pubmed: 30922927
Arch Gerontol Geriatr. 2012 Jul-Aug;55(1):145-7
pubmed: 21963175
Fam Pract. 2010 Apr;27(2):212-8
pubmed: 20022909
Biomark Insights. 2009 Aug 05;4:111-21
pubmed: 19707519
Lancet. 2003 Oct 11;362(9391):1225-30
pubmed: 14568747
Fam Pract. 2011 Dec;28(6):661-9
pubmed: 21653924
J Am Med Dir Assoc. 2015 Mar;16(3):229-37
pubmed: 25458444
J Gerontol. 1993 Nov;48(6):M266-71
pubmed: 8227997
Infect Dis Clin North Am. 2014 Mar;28(1):75-89
pubmed: 24484576
Scand J Prim Health Care. 2008;26(1):17-21
pubmed: 18297558
Scand J Prim Health Care. 2002 Sep;20(3):166-8
pubmed: 12389754
BMJ. 2009 May 05;338:b1374
pubmed: 19416992
J Am Geriatr Soc. 2013 Jan;61(1):62-6
pubmed: 23311553
Implement Sci. 2009 Aug 07;4:50
pubmed: 19664226
Int J Qual Health Care. 2007 Dec;19(6):349-57
pubmed: 17872937
Clin Microbiol Infect. 2019 Jul;25(7):839-844
pubmed: 30648603
Implement Sci. 2009 Sep 08;4:57
pubmed: 19737382
Arch Intern Med. 2005 Nov 28;165(21):2514-20
pubmed: 16314549
Clin Infect Dis. 2009 Jan 15;48(2):149-71
pubmed: 19072244
Cochrane Database Syst Rev. 2008 Jul 16;(3):CD001535
pubmed: 18646074