| Extract | Clinician quote |
|---|---|
| Challenges of diagnosing and managing suspected UTIs in everyday practice | |
| 1 | 'If they [the patients] are er fairly sure they have an uncomplicated UTI, i.e., no systemic features, er dysuria frequency and urgency, or at least two out of those three um, they’re happy with the diagnosis, they’re over eighteen, they’re not pregnant, um, and they don’t have any significant allergies or anything, we would usually prescribe them a three day course of trimethoprim over the phone. [I: 'Okay and, er, how confident do you feel in making the diagnosis of UTI?] 'Reasonably.' (England, GP, 3) |
| 2 | 'Sometimes it can be extremely difficult… Initial diagnosis can be, well, um, thrush in particular. Um, sometimes you can be, um, very confident but there are, there are cases where it can be quite, quite difficult and in those cases we would send the specimen for MSU.' (Wales, Practice Nurse, 7) |
| 3 | 'If the nitrite does not show anything and we use a culture and sometimes it is contaminated urine, so then it looks like there are bacteria on it while this is sometimes not the case. In most instances this is the case, but sometimes it may give an incorrect result, that some mixed flora is shown.' (the Netherlands, Nurse, 7) |
| Using Flexicult POCT to manage suspected UTI in a real practice setting | |
| 4 | 'I absolutely feel it [the Flexicult] would be added value to a GP practice because you are able to give more targeted and specific treatment… because you know straight away which antibiotics you should give, so I think that in the future those dipslides will become a thing of the past, that this Flexicult will become a nice innovation.' (the Netherlands, Nurse, 4) |
| 5 | 'I am now more aware that not everything should be identified as an urinary tract infection […] The only problem is that our only tool is the Labstix […] Maybe this is just temporary and afterwards we will revert to our usual habits, and you don't want to miss any infections.' (Spain, GP, 8) |
| 6 | 'I think we are probably more inclined with a lot of patients to send the samples and contact the patient if it comes back with an, with an infection rather than you know, just giving in to the patient I suppose when they’re sitting in front of you.' (Wales, Nurse, 5) |
| 7 | 'That would be quite exciting [I: mmhm] just to see something in front of me because obviously I don’t work in a lab, I haven’t been in a lab for years [I: mmhm] but it was something that I could see [I: mmhm] working or not working. […] even the receptionist [I: mmhm] "What are you doing?" [I: mmhm] "What are you growing?" [I: mmhm] so they were involved in the study.' (England, Practice Nurse, 5) |
| Using Flexicult POCT to manage suspected UTI in a real practice setting: disadvantages | |
| 8 | 'It’s all about time [I: yes, yes yes] so um, I know, at the end of the day, I wouldn’t, I certainly wouldn’t want to be doing er Flexicult on every single patient […] if this became routine to us [I: mmhm] well, we would be doing four times more, er, Flexicult than we did [in the trial] [I: right] and that would certainly need another, another member of staff, person to perform those tests really.' (Wales, GP, 1) |
| 9 | [On whether Flexicult might be used in the future in routine care] 'I wonder if it will actually happen, because they are expensive, they are more expensive than dipslides.' (the Netherlands, Nurse, 4) |
| 10 | 'Obviously if it was Friday, it was difficult because we weren’t going to be there and they did quite quickly overcook. I don’t know how well, erm, thermostatically regulated our oven was but, erm, if you left it much beyond the 24 hours because you forgot or a bit, er, too busy it would already begin to take an overall brown appearance.' (England, Nurse, 2) |
| 11 | 'By the time we finished we felt a lot more confident and actually felt we were doing it properly, er, and reading it off. I think I got, er, the doctors to look at the first one or two with me […] I think it became more useful probably just as we got more used to it.' (England, Nurse, 2) |
| Using Flexicult POCT to manage suspected UTI in a real practice setting: managing patient expectations | |
| 12 | 'At first I found it a bit difficult, I mean, yes, it will give you useful information in 24 hours but at the precise moment when you diagnose, then, and actually, it didn’t change my approach that much.' (Spain, GP, 6) |
| 13 | 'With a type of acute urinary tract infection where people have a lot of symptoms, […] people simply have a fever, or something like that, well then you are not going to wait. And some people, it is also a kind of service orientation, if people have a lot of symptoms and say they cannot cope, then you just cannot wait 24 hours.' (the Netherlands, Nurse, 3) |
| 14 | 'They liked it because they felt we were keeping an eye on them.' (Spain, GP, 9) |
| 15 | 'I think ladies are willing to, um, wait, uh, would be willing to wait more for a prescription if they knew that they were going to be getting some results in say 24 hours, as opposed to having to wait three or four days for a lab result.' (England, Practice Nurse, 6) |
| Impact of Flexicult on antibiotic prescribing in a real practice setting | |
| 16 | 'It was very positive and useful, because you would obtain the results in a very short period of time, so you would be able to contact the patient if the antibiotic you had prescribed wasn’t the right one. It is a technique which could be very useful in primary care.' (Spain, GP, 1) |
| 17 | [On the need for fast diagnosis systems for uncomplicated patients] 'I believe we don’t […] Actually, we don’t even use urine strips. Because it is actually very easy, with empirical treatment, in Spain at least, a monodose and that’s it.' (Spain, GP, 9) |
| 18 | 'I don’t feel it was a hugely time-consuming exercise, performing that, and if the patient, if a sample was requested it could be done, it didn’t have to be done there and then, it could be done later on [I: mmhm] later on in the morning.' (Wales, Research Nurse, 8) |
| Requirements of an optimal POCT | |
| 19 | ' … having it as a tool when in doubt, or in cases where, we sometimes speculate with treatment, to cover, don’t we? Because, in these cases, yes it would help. When you think "I wouldn’t prescribe it, but as I might have to wait a week for the urine culture, and it is a long time, then I prescribe it". If we had the Flexicult, in these cases, then maybe yes.' (Spain, GP, 2) |
| 20 | [On whether a POCT is useful in managing UTI] 'It, as I say, has not altered my, um, my prescribing um performance [I: yeah, mmhm] uhm, I don’t think it showed that I was missing [signs] [I: mmhm] I don’t think it showed that I was prescribing, er, antibiotics inappropriately, I think it, you know, my clinical judgment, I think, er, was fairly consistent with the results of the, uhm, cultures.' (Wales, GP, 1) |
| 21 | 'Turns a straightforward consultation into something that takes a long time [I: right] and then you’ve got to follow it up again the next day, so we just don’t have the time to do that.' (England, GP, 4) |
| 22 | 'It might seem quite easy, it’s easy to see a UTI, and just give people antibiotics and send them on their way [I: mmhm] but actually properly unpicking it and doing it properly longer term may save us a lot more in the future. So I reckon as a point of care test it is needed, it’s helpful.' (Wales, GP, 2) |
MSU = midstream urine. POCT = point of care test. UTI = urinary tract infection.