What's the catch? Urine sample collection from young pre-continent children: a qualitative study in primary care
Jonathan Kaufman1,2,3, Lena Sanci4, Meredith Temple-Smith4
1General Practice, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia jkaufman@unimelb.edu.au.
Insights
Collecting urine samples from young children with urinary tract infections (UTIs) in primary care is challenging. Key barriers include time and space, while parental motivation and education are crucial enablers for successful sample collection.
Area of Science:
- Pediatrics
- Infectious Diseases
- Primary Care Medicine
Background:
- Urinary tract infections (UTIs) are common in young children, posing diagnostic challenges due to difficulties in obtaining urine samples.
- Existing guidelines offer conflicting recommendations for urine sample collection in pre-continent children.
- Primary care clinicians face limited evidence on barriers and enablers affecting urine sample collection.
Purpose of the Study:
- To explore the barriers and enablers encountered by primary care clinicians when collecting urine samples from young, pre-continent children.
- To understand factors influencing the choice and utilization of different urine sample collection methods.
Main Methods:
- An exploratory qualitative study was conducted in Australian primary care settings.
- Semi-structured interviews were performed with 21 General Practitioners (GPs) and 4 practice nurses (PNs).
- Interviews focused on the process of collecting urine samples from a febrile child aged 6 months, employing thematic analysis.
Main Results:
- Five key themes emerged: clinician factors, patient characteristics, parental engagement, the collection process, and anticipated outcomes.
- Non-invasive methods were preferred, though clean catch was time-consuming and urine bags often contaminated.
- Barriers included time and space constraints; enablers involved parental motivation, educational materials, and voiding stimulation techniques.
Conclusions:
- The study identifies critical barriers and enablers for urine sample collection in primary care.
- Findings can inform educational strategies, policy development, and future research.
- Guideline recommendations need to be tailored to the realities of primary care practice for effective implementation.
Background:
Urinary tract infections (UTIs) are common in young pre-continent children, but collecting urine samples is challenging. Collection methods all have limitations and international guidelines have conflicting recommendations. Choice of method must balance time, resources, invasiveness, reliability, and contamination. Evidence from primary care clinicians is limited regarding barriers and enablers to sample collection, and what factors inform the choice and use of different sample collection methods.
Aim:
To understand the barriers and enablers to collecting urine samples from young pre-continent children in primary care.
Design & Setting:
An exploratory qualitative study performed in primary care in Australia.
Method:
Semi-structured interviews explored the topic of collecting a urine sample from a child aged 6 months who presented with a fever. The interviews were undertaken with 21 GPs and four practice nurses (PNs) until data saturation was reached. Interviews were audiorecorded, transcribed verbatim, coded, and underwent content and thematic analysis.
Results:
Five main themes emerged including: the clinician's knowledge and expertise; patient characteristics; parent or carer's understanding and motivation; the collection process itself; and likely outcome of the chosen method. Non-invasive methods were strongly favoured; although, clean catch was considered time-consuming and urine bags were known to be often contaminated. Invasive methods (for example, catheterisation or suprapubic aspiration [SPA]) were rarely performed outside of remote settings. Key barriers included time and space constraints in clinics, and key enablers included parental motivation, education handouts, and voiding stimulation methods.
Conclusion:
This study has identified key barriers and enablers to inform education, policy, and future research for urine sample collection from pre-continent children in primary care. Guideline recommendations must consider the primary care context to ensure they are relevant and suited to real-world practice.
Related Concept Videos
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:29Urine Studies I: Urinalysis
01:21Nursing Assessment of the Genitourinary System I: Health History
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:20Sputum Studies II: Culture and Sensitivity
Sputum culture and sensitivity is a medical procedure used to diagnose bacterial infections in the respiratory tract and select the most appropriate antibiotics for treatment. This process involves analyzing sputum samples of thick and opaque secretions produced in the lungs and airways. These samples are collected from patients and then sent to the laboratory for analysis.
The test can identify various pathogens responsible for respiratory infections, including Streptococcus,...
01:20Physiology of the Genitourinary System III: Urine Concentration and Dilution