E-Posters-Creating an Evidence-Based Care Pathway for Recurrent Urinary Tract Infections (rUTI) as Component of Value-Based Care

Creating an Evidence-Based Care Pathway for Recurrent Urinary Tract Infections (rUTI) as Component of Value-Based Care - Amy E Papermaster, NP-C, MSN, RN

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The objective of this study was to create a standardized care pathway for recurrent urinary tract infections (rUTIs) as part of value-based care. The researchers used a modified Delphi process, involving a multidisciplinary expert team, to review existing guidelines and literature on the diagnosis and treatment of rUTIs. Patient reported outcome measures, behavioral health, and pelvic floor measures were included in the pathway. To decrease costs, advanced practice providers manage patients, and physicians perform cystoscopy. Post-treatment culture is only done for patients with symptoms after completing antibiotic treatment. GU radiologic imaging is reserved for those who meet rUTI criteria and fail prevention strategies, excluding high-risk populations. Renal ultrasound is recommended as the first line for upper GU tract evaluation due to its high sensitivity and specificity, lower cost, and less patient radiation exposure. Treatment and prevention are conducted in partnership with the referring provider, and antibiotic therapy is based on patient factors and urine culture antibiotic sensitivity. Empiric therapy is initiated only in cases warranting critical intervention. For premenopausal women with coitally related rUTI, pericoital suppression may be initiated, while 6-month suppression is recommended for premenopausal women without coitally related rUTI and postmenopausal women. Topical estrogen cream is recommended for postmenopausal women without contraindications. Antibiotic agents are determined by regional antibiogram, effectiveness, and risk stratification. Vitamin C is discouraged, and cranberry is not routinely recommended. Hiprex and D-Mannose, as well as probiotics in premenopausal women, are distant third- and fourth-line treatments, respectively. After evaluation and treatment recommendations, patients are returned to the referring provider. Overall, the researchers developed a rUTI care pathway to standardize care across a diverse provider group in collaboration with referring providers.

Keywords

recurrent urinary tract infections

rUTIs

standardized care pathway

value-based care

modified Delphi process

multidisciplinary expert team

diagnosis and treatment

patient reported outcome measures

behavioral health

pelvic floor measures