Accepted for/Published in: JMIR Research Protocols
Date Submitted: Jan 6, 2020
Date Accepted: Feb 28, 2020
Reducing Antibiotic Prescriptions for Urinary Tract Infection in Nursing Homes: A Protocol for a Cluster Randomized Controlled Trial with a Complex, Tailored Intervention Targeting Nursing Home Staff.
ABSTRACT
Background:
Urinary tract infection (UTI) is the most common reason for antibiotic prescribing in nursing homes (NHs). Overprescribing cause antibiotic-related harms in those who are treated and in others residing within the NH. The diagnostic process in NHs is challenging. The physician rarely visits because of a suspected UTI. Therefore, he must rely on the clinical history provided by the NH staff. Consequently, the staffs´ knowledge of UTI and their communication skills influence the diagnosis.
Objective:
The study describes the testing of a tailored, complex intervention that aims to improve the quality of the interaction between NH staff and the physician hereby facilitating improved antibiotic prescribing for suspected UTI.
Methods:
The study describes an open-label cluster randomized controlled trial with two parallel groups and a 1:1 allocation ratio. Twenty-two eligible NHs is sampled from the Capital Region of Denmark, which corresponds to 1,274 NH residents. The intervention group receives a dialogue tool and all NH staff attends a 75-minute workshop on UTIs. The main outcomes of the study are the antibiotic prescription rate for UTI, all-cause hospitalization, all-cause death and suspected UTIs during the trial period.
Results:
As of January 2020, the trial is complete; data has been collected and is being analyzed. We expect the results of the trial to be published in the spring of 2020.
Conclusions:
The problem of excessive and inappropriate antibiotic use is common in NHs in most developed countries. The results of this trial could offer a strategy to solve some of the challenges of increased antibiotic resistance and have implications in terms of how to handle suspected UTI. Due to the applied tailoring process, some local tailoring may be required to apply the intervention in an alternate setting. Clinical Trial: Prospectively registered 2018-10-05 at ClinicalTrials.gov: NCT03715062
Citation
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