Decisions on antibiotic prescribing for suspected urinary tract infections in frail older adults: a qualitative study in four European countries.
Background a suspected urinary tract infection (UTI) is the most common reason to prescribe antibiotics in a frail older patient. Frequently, antibiotics are prescribed unnecessarily. To increase appropriate antibiotic use for UTIs through antibiotic stewardship interventions, we need to thoroughly...
| Publicado en: | Age & Ageing Vol. 51; no. 6; pp. 1 - 11 |
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| Autores principales: | , , , , , , , , , , , , , , , , |
| Formato: | Artículo |
| Publicado: |
Oxford University Press / USA
Jun2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=157756209&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 157756209 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Jun2022 vid: 51 iid: 6 pid: 622 pub: Oxford University Press / USA artinfo: ui: 157756209 10.1093/ageing/afac134 ppf: 1 ppct: 10 formats: tig: atl: Decisions on antibiotic prescribing for suspected urinary tract infections in frail older adults: a qualitative study in four European countries. aug: au: Hartman, Esther A R Groen, Wim G Heltveit-Olsen, Silje Rebekka Lindbæk, Morten Høye, Sigurd Sundvall, Pär-Daniel Skoglund, Ingmarie Arnljots, Egill Snaebjörnsson Gunnarsson, Ronny Kowalczyk, Anna Godycki-Cwirko, Maciek Kosiek, Katarzyna Platteel, Tamara N Pol, Alma C van de Verheij, Theo J M Monnier, Annelie A Hertogh, Cees M P M affil: Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam , De Boelelaan 1117, Amsterdam , the Netherlands Amsterdam Public Health Research Institute, Aging & Later Life , Amsterdam , the Netherlands Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University , Utrecht , the Netherlands The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo , Oslo , Norway General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland , Sweden Primary Health Care Clinic for Homeless People , Närhälsan, Region Västra Götaland , Sweden Centre for Family and Community Medicine, the Faculty of Health Sciences, The Medical University of Lodz , Lodz , Poland Family Doctors' Clinic , Lodz , Poland su: Netherlands Sweden Norway Poland Europe Interviewing Qualitative research Patients' attitudes Old age Antibiotics Antimicrobial stewardship Research Caregiver attitudes Urinary tract infections Research methodology Physicians' attitudes Treatment effectiveness Hospital nursing staff Decision making in clinical medicine sug: subj: Interviewing Qualitative research Patients' attitudes Old age Netherlands Sweden Norway Poland Europe Drugs and Druggists' Sundries Merchant Wholesalers Pharmaceuticals and pharmacy supplies merchant wholesalers Medicinal and Botanical Manufacturing Pharmaceutical and medicine manufacturing Offices of Physicians (except Mental Health Specialists) Offices of physicians Antibiotics Antimicrobial stewardship Research Caregiver attitudes Urinary tract infections Research methodology Physicians' attitudes Treatment effectiveness Hospital nursing staff Decision making in clinical medicine keyword: antibiotic stewardship decision-making older adults older people qualitative research urinary tract infections antibiotic stewardship decision-making older adults older people qualitative research urinary tract infections ab: Background a suspected urinary tract infection (UTI) is the most common reason to prescribe antibiotics in a frail older patient. Frequently, antibiotics are prescribed unnecessarily. To increase appropriate antibiotic use for UTIs through antibiotic stewardship interventions, we need to thoroughly understand the factors that contribute to these prescribing decisions. Objectives (1) to obtain insight into factors contributing to antibiotic prescribing for suspected UTIs in frail older adults. (2) To develop an overarching model integrating these factors to guide the development of antibiotic stewardship interventions for UTIs in frail older adults. Methods we conducted an exploratory qualitative study with 61 semi-structured interviews in older adult care settings in Poland, the Netherlands, Norway and Sweden. We interviewed physicians, nursing staff, patients and informal caregivers. Results participants described a chain of decisions by patients, caregivers and/or nursing staff preceding the ultimate decision to prescribe antibiotics by the physician. We identified five themes of influence: (1) the clinical situation and its complexity within the frail older patient, (2) diagnostic factors, such as asymptomatic bacteriuria, (3) knowledge (gaps) and attitude, (4) communication: interprofessional, and with patients and relatives and (5) context and organisation of care, including factors such as availability of antibiotics (over the counter), antibiotic stewardship efforts and factors concerning out-of-hours care. Conclusions decision-making on suspected UTIs in frail older adults is a complex, multifactorial process. Due to the diverse international setting and stakeholder variety, we were able to provide a comprehensive overview of factors to guide the development of antibiotic stewardship interventions. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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