Physician Preferences Surrounding UTI Management in Young Infants
Alan Schroeder
Lucile Packard Children's Hospital, Department of Pediatrics, Stanford University
Dr. Schroeder is the associate chief for research in the division of pediatric hospital medicine at Lucile Packard Children’s Hospital Stanford, and an associate clinical professor in the division of hospital medicine and the division of critical care. His research interests focus on identifying areas where we can “safely do less” in healthcare, and frequently lectures on this theme locally and nationally. Dr. Schroeder is currently involved in multiple projects involving common conditions in pediatrics such as head trauma, bronchiolitis, UTI, meningitis, and febrile infant management. He is a co-chair of the Lown RightCare Alliance Pediatric Council, co-chair of the Academic Pediatric Association’s Healthcare Value Special Interest Group, an editor of theYearbook of Pediatrics and an assistant editor for the journal Hospital Pediatrics. Dr. Schroeder provides clinical care for children in the PICU and the pediatric ward and has won multiple teaching awards.
Abstract
Introduction Variability exists in the treatment of young infants with urinary tract infection (UTI). Many infants are hospitalized for IV antibiotics well beyond clinical recovery. We designed a vignette survey to examine... [ view full abstract ]
Introduction
Variability exists in the treatment of young infants with urinary tract infection (UTI). Many infants are hospitalized for IV antibiotics well beyond clinical recovery. We designed a vignette survey to examine variability in physician preference for intravenous (IV) antibiotic duration, genitourinary imaging, and prophylactic antibiotics and to evaluate drivers of resource utilization.
Methods
A national case vignette survey was conducted of pediatricians sampled from the American Medical Association’s Physician MasterFile. Respondents were provided a case of a 2-week old infant female with febrile UTI, and asked to indicate preferences for IV antibiotic duration and to rank drivers of this decision. Respondents were additionally asked whether they would obtain a voiding cystourethrogram (VCUG) and, regardless of preference, were randomly presented either a normal result or bilateral grade II vesicoureteral reflux (VUR).
Results
The survey was e-mailed to 3528 physicians; 279 out of 438 opened surveys (63.7%) were completed. Preference for total IV antibiotic duration differed significantly (P < 0.001) across specialty, with a median total IV duration of 2 total days (0 additional days) for general pediatrics/hospitalists, 7 days for neonatology, and 5 days for infectious disease. No other demographic factors predicted IV duration. Drivers for this decision are depicted in Table 1. Fifty-three percent (n = 148) of respondents wanted a VCUG f. Among respondents (n=131) who did not want a VCUG, 24/61 (39%) would prescribe prophylactic antibiotics when the VCUG demonstrated grade II VUR, versus 0/70 when the VCUG was normal.
Discussion
In this survey of pediatricians, specialty was the most influential driver of IV antibiotic duration. Many physicians who initially expressed a preference against ordering additional imaging planned to prescribe prophylactic antibiotics when the results were abnormal thus even unwanted diagnostic test results drive treatment decisions.
Authors
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Neha Joshi
(Lucile Packard Children's Hospital, Department of Pediatrics, Stanford University)
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Brian Peter Lucas
(White River Junction Vermont VAMC and Geisel Medicine School at Dartmouth)
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Alan Schroeder
(Lucile Packard Children's Hospital, Department of Pediatrics, Stanford University)
Topic Areas
Prevalence and drivers of overuse , Harms of overuse (physical, psychological or system-related) , Organizational factors (such as structure and culture) that drive overuse
Session
OS-1 » Oral Presentations: Drivers of Overuse (09:30 - Friday, 5th May, Salons 4 & 5)
