Abstract
BackgroundUrinary tract infection (UTI) is the most common reason for antibiotic prescription in nursing homes. Overprescription causes antibiotic-related harms in those who are treated and others residing within the nursing home. The diagnostic process in nursing homes is complicated with both challenging issues related to the elderly population and the nursing home setting. A physician rarely visits a nursing home for suspected UTI. Consequently, the knowledge of UTI and communication skills of staff influence the diagnosis.ObjectiveThe objective of this study is to describe a cluster randomized controlled trial with a tailored complex intervention for improving the knowledge of UTI and communication skills of nursing home staff in order to decrease the number of antibiotic prescriptions for UTI in nursing home residents, without changing hospitalization and mortality.MethodsThe study describes an open-label cluster randomized controlled trial with two parallel groups and a 1:1 allocation ratio. Twenty-two eligible nursing homes are sampled from the Capital Region of Denmark, corresponding to 1274 nursing home residents. The intervention group receives a dialogue tool, and all nursing home staff attend a workshop on UTI. The main outcomes of the study are the antibiotic prescription rate for UTI, all-cause hospitalization, all-cause mortality, and suspected UTI during the trial period.ResultsThe trial ended in April 2019. Data have been collected and are being analyzed. We expect the results of the trial to be published in a peer-reviewed journal in the fall of 2020.ConclusionsThe greatest strengths of this study are the randomized design, tailored development of the intervention, and access to medical records. The potential limitations are the hierarchy in the prescription process, Hawthorne effect, and biased access to data on signs and symptoms through a UTI diary. The results of this trial could offer a strategy to overcome some of the challenges of increased antibiotic resistance and could have implications in terms of how to handle cases of suspected UTI.Trial RegistrationClinicalTrials.gov NCT03715062; https://clinicaltrials.gov/ct2/show/NCT03715062International Registered Report Identifier (IRRID)DERR1-10.2196/17710
Highlights
Urinary tract infection (UTI) is the most common reason for antibiotic prescription in elderly individuals living in nursing homes in Europe, and many of these prescriptions are considered inappropriate [1,2,3]
The objective of this study is to describe a cluster randomized controlled trial with a tailored complex intervention for improving the knowledge of UTI and communication skills of nursing home staff in order to decrease the number of antibiotic prescriptions for UTI in nursing home residents, without changing hospitalization and mortality
The aim of this study is to describe a protocol for evaluating the effects on antibiotic prescription, hospitalization, and death of a tailored complex intervention to improve the knowledge of UTI and communication skills among staff caring for residents with suspected UTI
Summary
Urinary tract infection (UTI) is the most common reason for antibiotic prescription in elderly individuals living in nursing homes in Europe, and many of these prescriptions are considered inappropriate [1,2,3]. Two dominant factors associated with elderly individuals living in nursing homes contribute to overtreatment It is widely accepted by nursing home staff that unspecific changes in behavior indicate UTI [6]. Objective: The objective of this study is to describe a cluster randomized controlled trial with a tailored complex intervention for improving the knowledge of UTI and communication skills of nursing home staff in order to decrease the number of antibiotic prescriptions for UTI in nursing home residents, without changing hospitalization and mortality. The potential limitations are the hierarchy in the prescription process, Hawthorne effect, and biased access to data on signs and symptoms through a UTI diary The results of this trial could offer a strategy to overcome some of the challenges of increased antibiotic resistance and could have implications in terms of how to handle cases of suspected UTI.
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