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美国初级保健医生对为尿路感染和复发性尿路感染提供指南驱动护理的障碍的看法:一种定性研究
Jennifer Park1, Michele Torosis1, Ja-Hong Kim1,2
1Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Box 951738, Los Angeles, CA, 90095-1738, USA.
由于资源不清楚和患者压力,初级保健提供者面临着遵守尿路感染 (UTI) 准则的挑战. 改进教育材料和算法可能会增强基于指南的尿路感染和复发性尿路感染 (rUTI) 的护理.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 传染性疾病 传染性疾病
- 初级医疗保健医学 一级医疗保健医学
背景情况:
- 尿路感染 (UTI) 非常普遍,影响许多女性,并且经常复发.
- 在医疗保健提供者中,遵守基于证据的尿路感染管理指南是不理想的.
- 本研究调查了初级保健提供者 (PCP) 在为尿路感染和复发性尿路感染 (rUTI) 提供指导方针一致的护理时所面临的障碍.
研究的目的:
- 确定PCP在实施基于指导方针的尿路感染和RUTI护理时遇到的障碍.
- 了解PCP决策流程和资源利用在管理UTI/rUTI.
- 为改善遵守UTI管理指南的战略提供信息.
主要方法:
- 与洛杉矶地区的18名PCP进行了半结构化采访.
- 基于理论的方法被用来分析采访成绩单.
- 该研究检查了临床管理,转诊决定和尿路感染/尿路感染的指导资源.
主要成果:
- PCP希望尿液培养,但由于患者的要求或接入障碍,通常会受到损害.
- 经验治疗值较低的患者与RUTI史,老年患者,或那些下降的评估.
- 实验室数据 (尿液分析,培养) 未得到充分利用;PCP经常将症状视为尿路感染,尽管培养结果是负面的,并且犹不决要开始预防.
- 提供者缺乏对指导方针的认识,依靠UpToDate®并推一些基于证据的预防策略.
结论:
- 缺乏明确,简洁的指导方针是适当的尿路感染/尿路感染治疗的重大障碍.
- 临床指导的可用性较差导致了关于预防措施和诊断测试的混乱.
- 患者获取问题有助于预期治疗的预期,强调需要改进提供者教育和管理算法,以提高指南一致性.
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