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

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

doi:10.3399/bjgpopen18X101630

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

BJGP Open. 2019 Jul 23;3(2):bjgpopen18X101630. doi: 10.3399/bjgpopen18X101630. Print 2019 Jul.

Authors

Lucy Brookes-Howell¹, Emma Thomas-Jones², Janine Bates³, Marie-Jet Bekkers³, Curt Brugman⁴, Elinor Coulman³, Nick Francis⁵, Khurram Hashmi⁶, Kerenza Hood⁷, Nigel Kirby⁸, Carl Llor⁹, Paul Little¹⁰, Michael Moore¹⁰, Anna Moragas^{11

12}, Kate Rumsby¹³, Theo Verheij¹⁴, Christopher Butler¹⁵

Affiliations

¹ Research Fellow (Qualitative), Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
² Research Fellow, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK thomas-jonese@cardiff.ac.uk.
³ Research Associate, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
⁴ Project Manager, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.
⁵ Professor, Division of Population Medicine, Cardiff University, Cardiff, UK.
⁶ GP Academic Fellow, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
⁷ Professor, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
⁸ Senior Data Manager, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
⁹ GP and Researcher, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
¹⁰ Professor, Primary Care & Population Sciences, University of Southampton, Southampton, UK.
¹¹ Project Manager, University Institute in Primary Care Research Jordi Gol, Via Roma Health Centre, Barcelona, Spain.
¹² GP and Associate Professor, University Rovira i Virgili. Primary Healthcare Centre Jaume I, Tarragona, Spain.
¹³ Study Manager, Primary Care & Population Sciences, University of Southampton, Southampton, UK.
¹⁴ Professor, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.
¹⁵ Professor of Primary Care, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

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.

Keywords: antibiotics; diagnosis; general practice; point-of-care testing; qualitative research; urinary tract infections.