ArticleEuropean geriatric medicine2019
Why are we misdiagnosing urinary tract infection in older patients? A qualitative inquiry and roadmap for staff behaviour change in the emergency department.
Article in European geriatric medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 10 citations in OpenAlex.
- Diagnosis of urinary tract infection in the emergency department - a real infection or an alarming indication for comprehensive geriatric assessment? A retrospective follow-up study.The Journal of frailty & aging · 2026Article
- Urine Testing in Children with Viral Symptoms: A Nationwide Analysis of Ambulatory Visits, 2014-2019.The Journal of pediatrics · 2025Article
- Preventing urinary tract infection in older people living in care homes: the 'StOP UTI' realist synthesis.BMJ quality & safety · 2025Review
- Strategies for older people living in care homes to prevent urinary tract infection: the StOP UTI realist synthesis.Health technology assessment (Winchester, England) · 2024Review
- The Importance of Diagnostics in the Treatment of Urinary Tract Infections in the United Kingdom.Research and reports in urology · 2024Article
- Decisions on antibiotic prescribing for suspected urinary tract infections in frail older adults: a qualitative study in four European countries.Age and ageing · 2022Article
- The impact of health care provider relationships and communication dynamics on urinary tract infection management and antibiotic utilization for long-term care facility residents treated in the emergency department: A qualitative study.American journal of infection control · 2021Article
- Gaps in communication between different staff groups and older adult patients foster unnecessary antibiotic prescribing for urinary tract infections in hospitals: a qualitative translation approach.Antimicrobial resistance and infection control · 2019Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe aim of this study was to identify the psychological and behavioural factors influencing clinicians managing older people with possible UTI in urgent care settings, and to develop an improvement roadmap.
methodsMichie's behaviour change wheel and COM-B (Capability, Opportunity, Motivation, Behaviour Change) models were used as the theoretical basis for this study. Semi-structured interviews were undertaken with 21 purposively selected medical and nursing staff in a large urban emergency department in the East Midlands, United Kingdom. Analysis was informed by the framework approach. A participatory design approach was used to develop an improvement roadmap.
resultsKey themes emerging from the semi-structured interviews included lack of knowledge on the role of urine dipstick testing, bias towards older people, automatic testing, time and resource constraints, pressures from peers and patients, and fear of the legal consequences of inaction. A thematic networks map indicated complex interactions between psychological and behavioural factors. Among more than 50 different intervention ideas identified by the workshop participants, two interventions were prioritised for implementation: i) controlling the use of dip stick urine tests; ii) providing individualised feedback to staff regarding the outcomes of patients diagnosed and treated for UTI.
conclusionsPsychological and behavioural factors play a significant role in the misdiagnosis of UTI in older people. Systematic approaches incorporating these factors might improve patient outcomes. Future studies should focus on implementation and evaluating their effectiveness and sustainability.
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