Managing urinary tract infections in nursing homes: a qualitative assessment.
OBJECTIVE
To elucidate the steps in the management of urinary tract infections (UTIs) in elderly nursing home residents, in order to derive data which would assist in an economic evaluation of such infections.


METHODS
Maximum variation sampling was used to recruit General Practitioners (GPs) and nurses (who worked in nursing homes), into the study. Using semi-structured interviews, a topic guide was used to explore diagnosis, treatment and the role of GPs and nurses in the management of UTIs in nursing home residents. Thematic analysis was employed to identify the main themes.


METHODS
A comprehensive description of the management of UTIs in nursing home residents that will be used in a future economic evaluation of the costs of this prevalent infection in this setting.


RESULTS
Ten GPs and nurses respectively took part in the interviews. Three overarching themes emerged from the interviews: information, processes and decision-making. Health care professionals described the key symptoms for diagnosis (information), testing procedures to confirm the presence of an infection (processes); many variations in management pathways were described. The nurse was central to decision-making in treatment i.e. prescribing of an antibiotic. Most GPs reported that they accepted the nursing staff's assessment of the resident and seldom visited a patient in a nursing home for a UTI.


CONCLUSIONS
The management approach to UTIs varied greatly and was a more complex process than anticipated. Identification of the component steps will be used to perform an economic evaluation of UTIs in nursing homes.
Schweizer
Anna K
AK
Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland.
Hughes
Carmel M
CM
Macauley
Domhnall C
DC
O'Neill
Ciaran
C
D000368:Aged; D001291:Attitude of Health Personnel; D019411:Clinical Laboratory Techniques; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009726:Nurses; D009735:Nursing Homes; D010821:Physicians, Family; D011785:Quality Assurance, Health Care; D011934:Reagent Strips; D013048:Specimen Handling; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000628:therapy* / Q000652:urine
D011934:Reagent Strips