To evaluate whether actively drawing physicians attention to the revised UTI guideline results in more appropriate AB prescribing for NH residents with suspected UTI. This will be achieved in two ways: 1) to incorporate the algorithm of the revised…
ID
Source
Brief title
Condition
- Bacterial infectious disorders
- Urinary tract signs and symptoms
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
inappropriate AB prescribing for suspected UTI at index consultation (yes/no)
Secondary outcome
Course of symptoms, alternative diagnosis at index consultation, changes in
treatment < 3 weeks, hospitalization, mortality, (other) complications, total
AB use at NH level.
Background summary
Recently, a urinary tract infection (UTI) treatment algorithm for frail elderly
is developed. The ministry of healthcare, welfare and sport has provided
funding for a Delphi study to develop this algorithm, after van Buul et al
(2015) showed that UTI accounts for the largest share of total antibiotic (AB)
use in NHs and that a third of these AB prescriptions seems not (yet) required.
The algorithm is incorporated in the revised guideline on UTI of the Dutch
Association of Elderly Care Physicians and Social Geriatricians (Verenso),
which will be published in October 2018.
Inappropriate AB use is an important problem both on the patient level (e.g.
side-effects and drug interactions) and the societal level (AB resistance). ln
the Netherlands, recent studies pointed to an increase in AB resistance in
nursing homes (NHs) and to a decrease in empirical AB treatment options for UTI
(Tholen 2016, Verhoef 2016, Hoogendoorn 2013, Van der Donk 2013). A swift
improvement of appropriate AB use is required.Therefore it is important that
the revised guideline will be used in practice. However, It is widely known
that the implementation of a guideline takes time.
Study objective
To evaluate whether actively drawing physicians attention to the revised UTI
guideline results in more appropriate AB prescribing for NH residents with
suspected UTI. This will be achieved in two ways: 1) to incorporate the
algorithm of the revised guideline into the electronic patient file and showing
the algorithm automatically when a clinician considers a UTI 2) an education
for physicians and nursing staff
Study design
A cluster randomized controlled trial (cRCT) with nursing homes as the unit of
randomization will be conducted to evaluate whether actively drawing physicians
attention to the revised urinary tract infections guideline results in more
appropriate AB prescribing. Quantitative (cRCT data) and qualitative approaches
(semi structured interviews and focus groups) will be combined to evaluate the
use and implementation of the UTI treatment decision tool.
Intervention
Actively drawing physicians attention to the revised UTI guideline by
incorporating the algorithm of the revised guideline into the electronic
patient file and showing it automatically when a clinician considers a UTI and
by educating physicians and nursing staff
Study burden and risks
The burden for the participating patients is minimal. Patients solely have to
decide to participate whether or not. The risks for the participating patients
is negligible. If our intervention is effective, a reduction in inappropriate
AB is expected. This will lead to less exposure to side-effects of antibiotics,
drug interactions and antibiotic resistance. Furthermore, knowledge about
implementation of a guideline will be acquired.
Van der Boechorststraat 7
Amsterdam 1081 BT
NL
Van der Boechorststraat 7
Amsterdam 1081 BT
NL
Listed location countries
Age
Inclusion criteria
new diagnosis *suspected UTI*
Exclusion criteria
- NH residents who already are taking ABs/have taken ABs in the previous 7days
for a different type of infection
- NH residents who do not wish to receive AB in case of a UTI according to
their treatment policy
Design
Recruitment
Medical products/devices used
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL66922.029.18 |