Antibiotic prescribing and non-prescribing for possible urinary tract infection in nursing home residents

The ANNA study has additionally led to recommendations for further research. Two of these follow-up studies have been already conducted by ANNA study team members, with the aid of financial support from the Regional Cooperative Networks Antibiotic Resistance (‘ABR zorgnetwerk’) of Noord-Holland West and Noord-Holland Oost / Flevoland and Utrecht. This includes a study on the observation of signs and symptoms of UTI in residents with impaired awareness or ability to communicate signs and symptoms, for example due to dementia (OKKO study). This study was set up in response to physicians and nurses that mentioned, in the ANNA study, that the study interventions seemed less feasible in this population. In the other study we described the process of urine dipstick use in nursing homes, and how this process can be improved (UrineSTICKs study). This study was set up in response to the ANNA study finding that urine dipstick use was common, despite the national guideline (of Verenso, the Dutch Association of Elderly Care Physicians) advising against this.

The interventions of the ANNA study and 2 follow-up studies were further developed in collaboration with a communication advisor, an implementation advisor and an education advisor of the Amsterdam UMC University Network of Organisations for care for older adults (UNO Amsterdam). Improvements identified in the process evaluation study were processed in new versions of the study interventions. In addition, these were professionalized with the aid of additional financial support of UNO Amsterdam. This resulted in the development of a ‘platform’ with knowledge products regarding UTI in frail older adults, on the website of UNO Amsterdam. Further, the products on this website are also referred to on websites of Verenso and Vilans (the national Centre of Expertise for Long-term Care in the Netherlands). Each product can be downloaded/used without any costs. Per product a description is available which, among other things, addresses what the product entails, for which target group it is intended, which recommendations we have for implementation, and what the evidence behind the product is. The following products from the ANNA, OKKO and UrineSTICKs studies are available on the website: