Ignite Creation Date:
2024-05-06 @ 12:13 PM
Last Modification Date:
2024-10-26 @ 12:55 PM
Study NCT ID:
NCT03700060
Status:
COMPLETED
Last Update Posted:
2018-10-09
First Post:
2018-04-09
Brief Title:
Communication and Compliance for Antibiotic Prescribing by General Practice to Nursing Home Residents With Suspected UTI
Sponsor:
Research Unit Of General Practice Copenhagen
Organization:
Research Unit Of General Practice Copenhagen
Study Overview
Official Title:
Communication and Compliance With Guidelines for Antibiotic Prescribing by General Practice to Nursing Home Residents With Suspected Urinary Tract Infections -A Research Protocol for a Cross-Sectional Study in the Primary Care Sector
Status:
COMPLETED
Status Verified Date:
2018-10
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Antibiotic resistance is becoming a bigger problem If the problem remains unsolved the WHO predicts a return to the pre-antibiotic era Overtreatment with antibiotics drives development of resistant bacteria and adverse events in patients thus identification and rectifying factors leading to unnecessary antibiotic prescriptions are a public health problem
Urinary Tract Infections UTIs are the most commonly diagnosed infection in nursing homes NH A prevalence study showed that in up to 76 of all antibiotic prescriptions in Danish NHs the indication was UTI In this particular group of patients with suspected UTI the literature has repeatedly shown that a vast amount of these antibiotic courses are inappropriate
As people age the prevalence of asymptomatic bacteriuria increases significantly Asymptomatic bacteriuria is a condition that should not be treated with antibiotics Thus the treatment decision in this group should not rely on the result of urinary testing and should only commence when classical urinary symptoms are present Urinary testing of NH residents is one of the drivers of overtreatment Therefore a recent Danish guideline from Institute of Rational Pharmacology IRF on elderly with suspected UTI suggest that urine culture should only be performed when typical urinary symptoms are present and that antibiotic prescribing should be delayed until the result of the culture is available whenever possible It is unknown to what extent Danish GPs follows these guidelines
NH residents are often immobile therefore the diagnostic process of UTI in NH residents differs from the norm which could also explain some part of the inappropriate prescribing Immobility introduces physical distance between patient and GP because the patient is unable to visit the General Practitioners office Because home visits are rare when a UTI is suspected NH staff usually contacts the GP in writing over the phone and occasionally in person to relate the patient history and physical findings
When another link in the communication chain between patient and GP is added clinical information passes through additional health professionals and the risk of communication error and misunderstanding increases Some forms of communications may be more suited to fit this setting than others When communicating in person it is possible to take non-verbal cues into account and immediately clear up insecurities Communication by phone eliminates non-verbal cues but a dialog about unclarified aspects is still attainable Written communication however has none of the clarifying traits of the former and to elaborate on the content the GP will have to contact the NH which takes time in an already packed schedule
The investigators hypothesize that the more direct the contact form the better the quality of clinical information which leads to increased compliance with guidelines Thus by proxy our hypothesis becomes that compliance to guidelines increases with directness of contact form The aim of this study is to investigate to which degree the guidelines on antibiotic prescribing for NH residents with suspected UTI are followed and how the communication form affects adherence to guidelines
Urinary Tract Infections UTIs are the most commonly diagnosed infection in nursing homes NH A prevalence study showed that in up to 76 of all antibiotic prescriptions in Danish NHs the indication was UTI In this particular group of patients with suspected UTI the literature has repeatedly shown that a vast amount of these antibiotic courses are inappropriate
As people age the prevalence of asymptomatic bacteriuria increases significantly Asymptomatic bacteriuria is a condition that should not be treated with antibiotics Thus the treatment decision in this group should not rely on the result of urinary testing and should only commence when classical urinary symptoms are present Urinary testing of NH residents is one of the drivers of overtreatment Therefore a recent Danish guideline from Institute of Rational Pharmacology IRF on elderly with suspected UTI suggest that urine culture should only be performed when typical urinary symptoms are present and that antibiotic prescribing should be delayed until the result of the culture is available whenever possible It is unknown to what extent Danish GPs follows these guidelines
NH residents are often immobile therefore the diagnostic process of UTI in NH residents differs from the norm which could also explain some part of the inappropriate prescribing Immobility introduces physical distance between patient and GP because the patient is unable to visit the General Practitioners office Because home visits are rare when a UTI is suspected NH staff usually contacts the GP in writing over the phone and occasionally in person to relate the patient history and physical findings
When another link in the communication chain between patient and GP is added clinical information passes through additional health professionals and the risk of communication error and misunderstanding increases Some forms of communications may be more suited to fit this setting than others When communicating in person it is possible to take non-verbal cues into account and immediately clear up insecurities Communication by phone eliminates non-verbal cues but a dialog about unclarified aspects is still attainable Written communication however has none of the clarifying traits of the former and to elaborate on the content the GP will have to contact the NH which takes time in an already packed schedule
The investigators hypothesize that the more direct the contact form the better the quality of clinical information which leads to increased compliance with guidelines Thus by proxy our hypothesis becomes that compliance to guidelines increases with directness of contact form The aim of this study is to investigate to which degree the guidelines on antibiotic prescribing for NH residents with suspected UTI are followed and how the communication form affects adherence to guidelines
Detailed Description:
None
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None