Background
Methods
Design
Setting
Sample
Respondent | Profession | Years of work experience | Sex | Nursing home | Number of residents and type of ward | Number of sites | Experience with POCT |
---|---|---|---|---|---|---|---|
A-I | Nurse | 25 | Female | A-a | 170 PG | 2 | No |
A-II | Elderly care physician | 4.5 | Female | A-b | 200 PG | 2 | No |
A-III | Nurse | 6 | Female | No | |||
A-IV | Elderly care physician | 14 | Female | A-c | 130 PG | 1 | No |
A-V | Elderly care physician in training | 5 | Male | A-d | 80 RB; 30 PG; 30 SOM | 1 | No |
A-VI | Elderly care physician | 19 | Female | A-f | 25 RB | 1 | No |
A-VII | Nurse | 29 | Female | No | |||
A-VIII | Elderly care physician | 18 | Female | A-g | 145 PG | 2 | No |
B-I | Elderly care physician | 35 | Male | No | |||
B-II | Elderly care physician in training | 5 | Female | a | 115 RB; 290 PG; 120 SOM | 5 | No |
B-III | Elderly care physician in training | 0.5 | Male | No | |||
B-IV | Elderly care physician | 16 | Female | No | |||
B-V | Nurse practitioner | 24 | Female | No | |||
B-VI | Nurse | 30 | Female | No | |||
C-I | Elderly care physician | 14 | Female | C-a | 90 PG | 1 | No |
C-II | Nurse | 34 | Female | No | |||
D-I | Elderly care physician in training | 1.5 | Female | D-a | 100 RB; 100 SOM | 1 | Yes |
D-II | Elderly care physician | 30 | Male | Yes |
Data collection
Data storage
Data analysis
Results
Respondents’ characteristics
Role of POCT in urinary tract infections
Only added value in case of non-specific symptoms
Well, if you’re not in doubt, then there’s no need, is there? If someone shows the full set [of symptoms], then in my view there’s no point in confirming it with POCT. A-IV
Then it’s fairly obvious. But the group who are able to express this clearly and accurately is very small. B-IV
Objective measure for ‘ruling out’ UTI
But sometimes you’re faced with people where you think: well, this is really very very different from what we usually see. And you then want to exclude [a UTI] some way or other, as it might still be that. A-II
So you want to have something more objective [...] regarding the severity of illness, to help you decide. So that [if the POCT] is below 20, you think, well, we can just as well wait and see. A-VIII
So I test it, and it’s a CRP [POCT] of 2. So at any rate you know it’s not an obvious infection. [But] I’m not sure it’s that reliable. A-V
The danger might be that someone is not treated who should be treated, as they would otherwise become more severely ill of their complaints persist. C-I
If POCT is zero, you can then say well, this is definitely not it. So you have a stronger argument. [ … ] You have an objective finding, in addition to what I see or hear myself. Not that I think that’s not reliable, but relatives often want a test or a scan. B-II
You want to check that your clinical impression is right. We doctors like that. To have some proof. A-VI
And that enables you to change direction sooner with this, well, in this area. A-II
But I would be [ … ] skeptical at first. Like, well, the CRP [POCT] is lower, so now I can’t treat them for UTI. [But] what then? C-I
And so you either start to treat because you feel you have to do something [ … ] Or you don’t, and then the complaints often persist anyway … And so at a later stage you still start to treat. A-V
Objective measure for ‘ruling in’ UTI
That would be really helpful. [ … ] You can do an abdominal exam. But is it tender: is it constipation or a bladder infection? Or do they just dislike the fact that you’re touching their belly? So for us, diagnostics is still a kind of intuition, and such a test would actually … A-IV
And if I then also find an elevated CRP [POCT], that would be an argument to say this is really a UTI. As I don’t have any other instrument. B-I
Perhaps it’s more a matter of seeing that if the POCT is elevated, you’ll give an antibiotic sooner, whereas that person would only become really ill tomorrow; so you [ … ] can get a timely start. D-I
But at [psychogeriatric wards] for instance, where there is less close clinical surveillance, there might be a group that you could treat a bit sooner. A-V
People may not be completely healthy, but not terribly ill either, so you think: it might be a UTI. But whether [ a POCT] would really rise that much in that kind of infection [ … ] I wonder. B-IV
You don’t know where the infection is located. It doesn’t have a specific … It could be anywhere. [ … ] You get all kinds of infections with the same signs. [ … ] You have to look at that carefully. [ … ] So [POCT] is just an addition to the toolkit. B-I
If you have someone with vague symptoms and a high [POCT], do you then know it’s a urinary tract infection? [ … ] The danger is that there’s an infection elsewhere, and that you treat them with nitrofurantoin and that that has no effect. B-IV
You preferably want to get it in context as much as possible. So not someone who also happens to have a cough and has just arrived on the rehabilitation ward, and might have a cystitis. Cos then you don’t know what you’re measuring. A-V
Balancing POCT and clinical reasoning
When I see a CRP of 100 and the patient doesn’t appear ill at all, I will not refer them to hospital straight away purely on [the basis of] this CRP. A-V
Sometimes you might do a POCT … And then you think, well, that’s not very high. And still the patient is so ill that you give them an antibiotic anyway. D-II
And in case of doubt; if I do see an elevated CRP [POCT] that makes me think right, there’s something going on there. And especially if it’s a very vulnerable patient, then I’ll think: let’s start treatment anyway. B-II
I think it’s more important for us to get clinical training about how to interpret test results and when to use them. [ … ] How about the specificity and sensitivity, can you use it to rule out, can you use it to rule in? B-III
You ought to know the predictive value of a test. [ … ] It’s just that we tend to forget that all the time. D-II
Role of POCT in other situations
And also to decide whether someone is not the way they usually are, or we can’t find out exactly what’s the matter. Then it’s sometimes interesting to know, well, could [it] have to do with an infection? A-VIII
That would be good, as for instance cellulitis, that’s sometimes an unclear picture here at the nursing home. [ … ] Then you have a much more powerful argument to start antibiotics. A-V
Of course sometimes you get vague abdominal symptoms that make you think: is this a cholecystitis or gall stones or what? I could imagine that you might be able to differentiate with that too. A-IV
Yeah, sometimes you get people who deteriorate, and you can’t put your finger on it. Is it an airways infection rather than a urinary infection? So you’re at a loss. And you then check which way it’s developing. For prognosis too. A-IV
If people are ill and you ask yourself can I safely leave this patient here or should I refer them to an orthopedist for a check-up as we’re thinking it might be an infection of the hip, for instance. D-II
Except, well, it’s not really intended for, we don’t have official cut-off values. Well. So then it’s still your own interpretation of the overall … A-VIII
Well, so where’s the threshold? I think it’s very important to put it in context and link it to the evidence base. A-V