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Improved management of cystitis in primary care following the implementation of a simple multifaceted intervention
Affiliation:1. Primary Care Pharmacy Unit, Catalonian Institute of Health, Barcelona, Spain;2. Territorial Manager of the Primary Care Area of Barcelona City, Catalonian Institute of Health, Spain;3. Microbiology Department, Vall d’Hebron University Hospital, Catalonian Institute of Health, Barcelona, Spain;4. Via Roma Health Centre, Catalonian Institute of Health, Barcelona, Spain;5. CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Spain
Abstract:ObjectiveWe assessed the impact of the implementation of a simple multifaceted intervention aimed at improving management of cystitis in primary care.DesignQuality control before and after study.SitePrimary care centres in Barcelona city provided by the Catalonian Institute of Health.ParticipantsThe multifaceted intervention consisted of (1) creation of a group with a leader in each of the primary care centres, out of hours services, sexual and reproductive centres, and home visit service, (2) session on management of cystitis in each centre, (3) result feedback for professionals, and (4) provision of infographics for professionals and patients with urinary tract infections. Interventions started in November 2020 and ended in the summer of 2021.Main measurementsVariation in the prescription of first-line antibiotics, usage of antibiotics, and request for urine cultures before and after this intervention.ResultsTraining sessions took place in 93% of the centres. The use of first-line therapies cystitis increased by 6.4% after the intervention (95% confidence interval [CI], 5.7–7.1%). The use of nitrofurantoin in recurrent cystitis increased, mainly in out of hours service (8.7%; 95% CI, 5.2–12.2%). Urine cultures were more frequently requested after the intervention for recurrent cystitis in both primary care centres and out of hours services, with a 7.2% increase [95% CI, 5.9–8.5%), but also for uncomplicated urinary tract infections (3.1%; 95% CI, 1.8–4.4%).ConclusionsA low-intensity multifaceted intervention on management of cystitis, with strong institutional support, resulted in a better choice of antibiotic in antibiotic prescribing, but the intervention had less impact on the adequacy of urine cultures.
Keywords:Antimicrobial stewardship  Antibacterial agents  Primary health care  Urinary tract infections  Urine culture  Programas de optimización de antibióticos  Antibióticos  Atención primaria  Infecciones del tracto urinario  Urocultivo
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