Clinicians are still prone to incorrectly assess and overdiagnose urinary tract infections among nursing home residents, with nurses most likely to do so, investigators have told McKnight’s Clinical Daily.
Researchers from the University of North Carolina examined the rate of diagnosis of suspected UTI using a national survey sample of nursing home clinicians. Primary care providers and nurses were asked to assess whether a UTI was likely in a variety of hypothetical scenarios. Responses, from more than 1,700 participants, were compared to standardized UTI assessment guidelines.
Participants were only moderately able to accurately diagnose the likely presence or absence of UTIs. As a group, primary care providers and RNs misclassified UTIs approximately one-third of the time, the researchers reported. Nurses had greater odds of an incorrect assessment than the primary care physicians and physicians assistants who participated in the study.
The analysis found a randomness to some of the assessments. “Overall, clinicians’ rate of false positive diagnoses of patients without UTI was not much better than flipping a coin,” wrote lead author Christine E. Kistler, M.D., of the University of North Carolina. In contrast, the false negative rate (for patients who do have UTIs) was much lower, she and her colleagues added.
Overdiagnosis of UTIs is “still a problem,” despite decades of attempts to reduce overprescribing and improve antibiotic stewardship in nursing homes, Kistler told McKnight’s. Based on her team’s analysis of clinician UTI knowledge, attitudes, personality and other characteristics, some of the problem stems from lack of knowledge about UTIs, and some can be attributed to general attitudes and even to close-mindedness, she said.
Training efforts have “disappointing” results
“Given the tremendous efforts to train and educate nursing home clinicians on the clinical characteristics of a UTI, and the immense scrutiny that CMS has placed on appropriate antibiotic prescribing, these results are disappointing,” she and her colleagues wrote in the study, published Jan. 11 in the Journal of the American Geriatrics Society.
The solution? Wide implementation of electronic clinical decision support that has been recommended by the Centers for Disease Control and Prevention, the researchers said. This would help to improve point-of-care infection identification and antibiotic prescribing, they wrote.
“That effort, combined with multicomponent educational efforts targeted at specific clinician personalities, may help more permanently reduce antibiotic overuse,” they concluded.