Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Chan SL(1), Yiu MP(1), Wan KY(1)
Affiliation :
(1)Department of FM&PHC, Kowloon West Cluster
Introduction :
Urinary tract infection (UTI) is a common infection encountered in primary care setting. Local microbiology spectrum and various local guidelines suggested similar recommendations on use of urine culture and antibiotics use, while the use and duration of oral pyridium are not particularly emphasized usually. This audit aims to review and improve the management of uncomplicated UTI in primary care setting with revision of the guidelines.
Objectives :
The audit criteria consists of three areas of assessment: (1) Appropriate use of midstream urine (MSU) culture to aid diagnosis and antibiotics sensitivity, (2) Choice and duration of antibiotics, and (3) Timely use and appropriate duration of oral pyridium.
Methodology :
Relevant guidelines and appropriate management of uncomplicated UTI were discussed in clinic meetings and memos were placed at consultation rooms as reminders. 30 consultations were audited in the first (7-9/2022) and second cycle (2-5/2023) respectively.
Result & Outcome :
In the first cycle, most doctors (82%) were alerted of conditions that MSU culture were needed, for example patients with atypical symptoms, suspected acute pyelonephritis or symptoms that do not resolve or that recur within 4 weeks after completion of treatment. In contrary, the awareness towards oral pyridium use and its duration was insufficient. Prolonged use of oral pyridium is not recommended in uncomplicated UTI as it may mask a worsening infection or cause unnecessary side effects. In the second cycle, most audit criteria showed significant improvement. 88% (compared with 32% in the first cycle) consultations did not save unnecessary MSU culture in patients with typical symptoms, which reduced cost of excessive investigations and patient’s anxiety. Consultations selecting appropriate antibiotics with correct dosage and duration improved from 80% to 100%, while prescribing oral pyridium for patients with dysuria improved from 60% to 93% after the audit intervention. Consultations prescribing oral pyridium of correct duration (within 2 days) when in use of antibiotics increased from 8% to 70%. Overall, the audit intervention was effective. The result of different degrees in fulfilling various audit aspects was compatible with the proportion of emphasis in common local guidelines on UTI which usually guidance on pyridium use was relatively limited. Future revision of guidelines or audit on UTI may place more emphasis on this area of deficiency.
