TY - JOUR

T1 - Development of quality indicators for the diagnosis and treatment of urinary tract infections in general practice

T2 - a RAND appropriateness method

AU - Saust, Laura Trolle

AU - Siersma, Volkert Dirk

AU - Bjerrum, Lars

AU - Hansen, Malene Plejdrup

N1 - © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2023

Y1 - 2023

N2 - OBJECTIVE: To develop a set of quality indicators for the diagnosis and antibiotic treatment of adult patients with suspected urinary tract infections in general practice.DESIGN: A Research and Development/University of California Los Angeles appropriateness method was used.SETTING: Danish general practice.SUBJECTS: A panel of nine experts, mainly general practitioners, was asked to rate the relevance of 27 preliminary quality indicators. The set of indicators was based on the most recent Danish guidelines for the management of patients with suspected urinary tract infection. An online meeting was held to resolve misinterpretations and achieve consensus.MAIN OUTCOME MEASURES: The experts were asked to rate the indicators on a nine-point Likert scale. Consensus of appropriateness was reached if the overall panel median rating was 7-9 with agreement. Agreement was defined as: no more than one expert rated the indicator outside the three-point region (1-3, 4-6 and 7-9) containing the median.RESULTS: A total of 23 of the 27 proposed quality indicators attained consensus. One additional indicator was proposed by the panel of experts, leading to a final set of 24 quality indicators. All indicators focusing on the diagnostic process achieved consensus of appropriateness, while the experts agreed on three quarters of the proposed quality indicators concerning either the treatment decision or the choice of antibiotics.CONCLUSION: This set of quality indicators may be used to strengthen general practice's focus on the management of patients with a possible urinary tract infection and to identify potential quality problems.

AB - OBJECTIVE: To develop a set of quality indicators for the diagnosis and antibiotic treatment of adult patients with suspected urinary tract infections in general practice.DESIGN: A Research and Development/University of California Los Angeles appropriateness method was used.SETTING: Danish general practice.SUBJECTS: A panel of nine experts, mainly general practitioners, was asked to rate the relevance of 27 preliminary quality indicators. The set of indicators was based on the most recent Danish guidelines for the management of patients with suspected urinary tract infection. An online meeting was held to resolve misinterpretations and achieve consensus.MAIN OUTCOME MEASURES: The experts were asked to rate the indicators on a nine-point Likert scale. Consensus of appropriateness was reached if the overall panel median rating was 7-9 with agreement. Agreement was defined as: no more than one expert rated the indicator outside the three-point region (1-3, 4-6 and 7-9) containing the median.RESULTS: A total of 23 of the 27 proposed quality indicators attained consensus. One additional indicator was proposed by the panel of experts, leading to a final set of 24 quality indicators. All indicators focusing on the diagnostic process achieved consensus of appropriateness, while the experts agreed on three quarters of the proposed quality indicators concerning either the treatment decision or the choice of antibiotics.CONCLUSION: This set of quality indicators may be used to strengthen general practice's focus on the management of patients with a possible urinary tract infection and to identify potential quality problems.

KW - Adult

KW - Humans

KW - Quality Indicators, Health Care

KW - General Practice

KW - Family Practice

KW - Consensus

KW - Anti-Bacterial Agents/therapeutic use

KW - Urinary Tract Infections/diagnosis

U2 - 10.1136/bmjoq-2022-002156

DO - 10.1136/bmjoq-2022-002156

M3 - Journal article

C2 - 37230738

VL - 12

JO - BMJ Open Quality

JF - BMJ Open Quality

SN - 2399-6641

IS - 2

ER -