title: Guidelines adherence to lower urinary tract infection treatment in out-of-hours primary care in European countries.
abstract: BACKGROUND
  The substantial prevalence of bacterial lower urinary tract infections (LUTIs) in out-of-hours (OOH) primary care is a reason for frequent prescription of antibiotics. Insight in guideline adherence in OOH primary care concerning treatment of LUTIs is lacking.
  
  
  OBJECTIVE
  To check feasibility of the use of OOH routine data to assess guideline adherence for the treatment of LUTI in OOH primary care, in different regions of Europe.
  
  
  METHODS
  We compared guidelines for diagnosis and treatment of uncomplicated LUTIs in nine European countries, followed by an observational study on available data of guideline adherence. In each region a convenience sample of registration data of at least 100 contacts per OOH primary care setting was collected. Data on adherence (% of contacts) was identified for type of antibiotic and for full treatment adherence (i.e. recommended type and dose and duration).
  
  
  RESULTS
  Six countries were able to provide data on treatment of LUTIs. Four of them succeeded to collect data on type, dosage and duration of treatment. Mostly, trimethoprim was the treatment of first choice, sometimes combined with sulfamethoxazol or sulfamethizol. Adherence with the type of antibiotics varied from 25% to 100%. Denmark achieved a full treatment adherence of 40.0%, the Netherlands 72.7%, Norway 38.3%, and Slovenia 22.2%.
  
  
  CONCLUSIONS
  Guidelines content is similar to a large extent in the participating countries. The use of OOH routine data for analysis of guideline adherence in OOH primary care seems feasible, although some challenges remain. Adherence regarding treatment varies and suggests room for improvement in most countries.
authors.affiliation: Department of Primary and Multidisciplinary Care, General Practice, University of Antwerp, Universiteitsplein 1, gebouw R, 3de Verd., B-2610 Wilrijk, Belgium. Hilde.philips@uantwerpen.be.
authors.forename: Hilde
authors.initials: H
authors.lastname: Philips
authors.affiliation: Radboud University Medical Centre, Nijmegen, Scientific Institute for Quality of Healthcare, Netherlands.
authors.forename: Linda
authors.initials: L
authors.lastname: Huibers
authors.affiliation: National Centre for Emergency Primary Health Care, Uni Research, Uni Health, Norway; Haraldsplass Deaconess University College, Norway.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Holm Hansen
authors.affiliation: Research Unit and Department for General Practice, Aarhus University, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Bondo Christensen
authors.affiliation: Department of General Practice and Health Services Research, University of Heidelberg, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Leutgeb
authors.affiliation: Department of Family Medicine, Medical School, University of Maribor, and Department of Family Medicine, Medical School, University of Ljubljana, Slovenia.
authors.forename: Zalika
authors.initials: Z
authors.lastname: Klemenc-Ketis
authors.affiliation: Institute of General Practice and Health Services Research University of Zurich, Switzerland.
authors.forename: Corinne
authors.initials: C
authors.lastname: Chmiel
authors.affiliation: Primary Healthcare University Research Institute IDIAP-Jordi Gol and Catalan Institute of Health, Barcelona, Spain.
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Muñoz
authors.affiliation: Department of Family and Community Medicine, Medical University of Lodz, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Kosiek
authors.affiliation: Department of Primary and Multidisciplinary Care, General Practice, University of Antwerp, Belgium.
authors.forename: Roy
authors.initials: R
authors.lastname: Remmen
mesh_terms: D039602:After-Hours Care / Q000592:standards* / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D004363:Drug Utilization; D005060:Europe; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards; D014552:Urinary Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents