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WEST PALM BEACH, Fla., Sep 22, 2003 (United Press International via COMTEX) -- New research shows urinary tract infections can be managed safely and conveniently over the phone, with low recurrence rates and a low incidence of other gynecological complications.
UTIs result in nearly 8 million visits annually to doctors' offices in the United States and about one-third of all American women have at least one UTI by age 24.
"We found that telephone-managed treatment of UTI is comparable to office-based care, is much more convenient for the patient and more efficient for physicians and healthcare providers," said lead researcher, Dr. David Vinson, of the Permanente Medical Group in Sacramento, part of the California health maintenance organization, Kaiser Permanente. "This is the first study to look at outcomes of treatment as a way of verifying its efficacy."
As reported at the recent Interscience Conference on Antimicrobial Agents and Chemotherapy in Chicago, Dr. Vinson and colleagues evaluated data on 4,177 women who had received treatment over seven weeks through Kaiser Permanente's regional advice and appointment call center.
Nurse practitioners screened the women for UTI treatment using a highly structured interview process designed to identify women who might have other conditions. To receive a UTI diagnosis, the subjects were required to have at least one UTI marker symptom lasting for up to 10 days, including burning or pain during urination, an increase in urinary frequency, urgency or pressure, increased urination at night or blood in the urine.
The women diagnosed with UTI were prescribed antibiotics lasting three to seven days and were counseled during that period. The researchers found low rates of recurrence within six weeks and none of the patients required hospitalization, or developed toxic urine -- a potentially life-threatening condition.
"This study again validates the safety of telephone evaluation and treatment by a physician or nurse for common urinary tract infections without complications," Dr. Patricia Conolly, Kaiser Permanente's regional clinical director for its Northern California Appointment and Advice Call Center, told United Press International. "We recognize that our health care system is somewhat unique in that our nurses and physicians have direct access to online health information about our patients and are trained to use explicit protocols with clearly defined criteria. We are able to offer women with uncomplicated urinary tract infections prompt, convenient treatment."
Other primary caregivers, who do not have access to online health information about the patient and explicit protocols to utilize, might not be able to use telephone evaluations effectively, Conolly added. "We have found that many of our patients are well-informed regarding uncomplicated health problems like this and value prompt treatment and the convenience of avoiding a trip to the doctor's office."
Looking at the economic implications, she said although there might be a reduction in the cost of providing care because an office visit is not necessary, "our protocols for telephone evaluation require both physician and nursing time, as well as the same end-result of prescribing medication."
The real benefit lies in the ability of providers such as Kaiser Permanente "to provide care which we know is safe, in a more prompt and convenient way to women with this condition," and thereby avoid higher payouts because of UTI complications, she said.
Conolly said Kaiser Permanente also is using a nurse-managed, telephone protocol to diagnosis strep throat. She said the patients who exhibit symptoms "would obviously have to come in to have a throat cultures taken (but the phone counseling can) "alleviate quickly the anxiety of a ... parent of a symptomatic child, by the use of a structured telephone protocol to either say 'yes' or 'no' to the question of whether to get their child to the doctor's office."
Therefore those who do not need to see a doctor will not consume valuable medical time and dollars, she added.
"I don't advocate including the elderly or those with complications, such as diabetes, in telephone triage," Dr. Thomas Hooton, professor of allergy and infectious disease at the University of Washington in Seattle, told UPI. "Most studies have been limited to young healthy women and have shown good results. I would like to see more positive data in those with potentially complicated urinary tract infections before I am comfortable with this
management strategy."
Copyright 2003 by United Press International.
