Recurrent UTI in young women 100 day challenge

Aim of 100 day challenge To deliver service improvement in 100 days with no impediment or blockages and support from CCG and Hospital management to bring about changes within a multidisciplinary team Virtual clinics Pathways Shared decision making Use of allied health care professionals Joint clinics

Urology Projects Nurse led virtual follow up clinics following bladder outflow obstruction surgery – Live Joint continence clinic – Physio in association with Consultant – improve patient flow, decrease DNA, allowing seamless transition between community and specialist – Live Improve treatment of recurrent UTI in younger women – currently trialling in 4 GP practices and collating feedback before formal launch across West Suffolk

The Global Problem UTIs are one of the most frequent clinical bacterial infections in women, accounting for nearly 25% of all infections. Around 50–60% of women will experience a UTI in their lifetime. The estimated number of UTIs per person per year is 0.5 in young females Recurrent uncomplicated UTIs are common among young, healthy women even though they generally have anatomically and physiologically normal urinary tracts. In a study of college women with their first UTI, 27% experienced at least one culture-confirmed recurrence within the six months following the initial infection and 2.7% had a second recurrence during this same time period Antibiotic prescriptions for UTI account for 10-20% of all antibiotic prescriptions in ambulatory care and are second only to antibiotic prescriptions for respiratory tract infections

The local problem In 16-45 year old women – the only tests recommended are USS – if normal then education and SDM is the way they should be treated No readily available Shared Decision Making tool or education sessions available for recurrent UTI and so often no intervention apart from acute courses of antibiotics for these women This leads to a considerably burden of repeated attendances in primary care for antibiotics without allowing women to take control of their chronic condition. Myth that young women with recurrent UTI need specialist tests (cystoscopy) to rule out pathology Referrals for recurrent UTI and all general urology referrals increasing

Current Treatment pitfalls At presentation- delay in seeing GP and needing to miss work to attend GP to get antibiotics Once treated – Often no advice on avoiding recurrence as no readably available tool to give them advice As no advice – then nothing changes – more UTI – more antibiotics When get to a certain no of UTI – may get referred to secondary care? Triggers? Expectations? Secondary care (significant delay) – Just giving advice and checking USS ok – no other action

100 day challenge solutions At presentation- delay in seeing GP and needing to miss work to attend GP to get antibiotics Streamlined dipstick protocol for primary care with clinical information check list for the woman to leave at GP on the same day with phone call back same day with the results.

100 day challenge solutions 2. Once treated – Often no advice on avoiding recurrence as no readably available tool to give them advice In Urine specimen pack the ladies will receive a business card signposting to them to an online SDM booklet (see packs) Posters in surgeries/colleges again signposting them to the resource

100 day challenge solutions 3. As no advice – then nothing changes – more UTI – more antibiotics Alongside this SDM booklet they will also be invited to a shared educational session run by an allied healthcare professional that they can email to book directly (see packs)

100 day challenge solutions 4. When get to a certain no of UTI – may get referred to secondary care? Triggers? Expectations? 5. Secondary care – Just giving advice and checking USS ok – no other action As they have had SDM booklet then they can make informed decisions about their care/Take control of their chronic condition. A new treatment algorithm alongside the booklet to support primary care so they can be treated closer to home and earlier.

Thank you Please feel free to ask questions during the Q and A sessions.