OBJECTIVES: To determine whether a nurse led education and direct access service improves the care of children with urinary tract infections. DESIGN: Prospective cluster randomised trial. SETTING:General practitioners in the catchment area of a UK paediatric nephrology department. PARTICIPANTS: 88 general practices (346 general practitioners, 107 000 children). MAIN OUTCOME MEASURES: Rate and quality of diagnosis of urinary tract infection, use of prophylactic antibiotics, convenience for families, and the number of infants with vesicoureteric reflux in whom renal scarring may have been prevented. RESULTS: The study practices diagnosed twice as many urinary tract infections as the control practices (6.42 v 3.45/1000 children/year; ratio 1.86, 95% confidence interval 1.42 to 2.44); nearly four times more in infants (age < 1 year) and six times more in children without specific symptoms. Diagnoses were made more robustly by study practices than by control practices; 99% v 89% of referred patients had their urine cultured and 79% v 60% had bacteriologically proved urinary tract infections (P < 0.001 for both). Overall, 294 of 312 (94%) children aged under 4 years were prescribed antibiotic prophylaxis by study doctors compared with 61 of 147 (41%) by control doctors (P < 0.001). Study families visited hospital half as much as the control families. Twice as many renal scars were identified in patients attending the study practices. Twelve study infants but no control infants had reflux without scarring. CONCLUSION: A nurse led intervention improved the management of urinary tract infections in children, was valued by doctors and parents, and may have prevented some renal scarring.
RCT Entities:
OBJECTIVES: To determine whether a nurse led education and direct access service improves the care of children with urinary tract infections. DESIGN: Prospective cluster randomised trial. SETTING: General practitioners in the catchment area of a UK paediatric nephrology department. PARTICIPANTS: 88 general practices (346 general practitioners, 107 000 children). MAIN OUTCOME MEASURES: Rate and quality of diagnosis of urinary tract infection, use of prophylactic antibiotics, convenience for families, and the number of infants with vesicoureteric reflux in whom renal scarring may have been prevented. RESULTS: The study practices diagnosed twice as many urinary tract infections as the control practices (6.42 v 3.45/1000 children/year; ratio 1.86, 95% confidence interval 1.42 to 2.44); nearly four times more in infants (age < 1 year) and six times more in children without specific symptoms. Diagnoses were made more robustly by study practices than by control practices; 99% v 89% of referred patients had their urine cultured and 79% v 60% had bacteriologically proved urinary tract infections (P < 0.001 for both). Overall, 294 of 312 (94%) children aged under 4 years were prescribed antibiotic prophylaxis by study doctors compared with 61 of 147 (41%) by control doctors (P < 0.001). Study families visited hospital half as much as the control families. Twice as many renal scars were identified in patients attending the study practices. Twelve study infants but no control infants had reflux without scarring. CONCLUSION: A nurse led intervention improved the management of urinary tract infections in children, was valued by doctors and parents, and may have prevented some renal scarring.
Authors: Alastair D Hay; Jonathan A C Sterne; Kerenza Hood; Paul Little; Brendan Delaney; William Hollingworth; Mandy Wootton; Robin Howe; Alasdair MacGowan; Michael Lawton; John Busby; Timothy Pickles; Kate Birnie; Kathryn O'Brien; Cherry-Ann Waldron; Jan Dudley; Judith Van Der Voort; Harriet Downing; Emma Thomas-Jones; Kim Harman; Catherine Lisles; Kate Rumsby; Stevo Durbaba; Penny Whiting; Christopher C Butler Journal: Ann Fam Med Date: 2016-07 Impact factor: 5.166
Authors: Christopher C Butler; Kathryn O'Brien; Timothy Pickles; Kerenza Hood; Mandy Wootton; Robin Howe; Cherry-Ann Waldron; Emma Thomas-Jones; William Hollingworth; Paul Little; Judith Van Der Voort; Jan Dudley; Kate Rumsby; Harriet Downing; Kim Harman; Alastair D Hay Journal: Br J Gen Pract Date: 2015-04 Impact factor: 5.386
Authors: Christopher C Butler; Jonathan Ac Sterne; Michael Lawton; Kathryn O'Brien; Mandy Wootton; Kerenza Hood; William Hollingworth; Paul Little; Brendan C Delaney; Judith van der Voort; Jan Dudley; Kate Birnie; Timothy Pickles; Cherry-Ann Waldron; Harriet Downing; Emma Thomas-Jones; Catherine Lisles; Kate Rumsby; Stevo Durbaba; Penny Whiting; Kim Harman; Robin Howe; Alasdair MacGowan; Margaret Fletcher; Alastair D Hay Journal: Br J Gen Pract Date: 2016-07 Impact factor: 5.386