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.

AIMS: 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%.

CONCLUSION: 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.

Written by:
Philips H, Huibers L, Holm Hansen E, Bondo Christensen M, Leutgeb R, Klemenc-Ketis Z, Chmiel C, Muñoz MA, Kosiek K, Remmen R.   Are you the author?
Department of Primary and Multidisciplinary Care, General Practice, University of Antwerp, Universiteitsplein 1, gebouw R, 3de Verd., B-2610 Wilrijk, Belgium; Radboud University Medical Centre, Nijmegen, Scientific Institute for Quality of Healthcare, Netherlands; National Centre for Emergency Primary Health Care, Uni Research, Uni Health, Norway; Haraldsplass Deaconess University College, Norway; Research Unit and Department for General Practice, Aarhus University, Denmark; Department of General Practice and Health Services Research, University of Heidelberg, Germany; Department of Family Medicine, Medical School, University of Maribor, and Department of Family Medicine, Medical School, University of Ljubljana, Slovenia; Institute of General Practice and Health Services Research University of Zurich, Switzerland; Primary Healthcare University Research Institute IDIAP-Jordi Gol and Catalan Institute of Health, Barcelona, Spain; Department of Family and Community Medicine, Medical University of Lodz, Poland.  

Reference: Qual Prim Care. 2014;22(4):221-31.

PubMed Abstract
PMID: 25695532 Infections Section