Evidence-based Texting Platform for Recurrent Urinary Tract Infection Management

Objectives: Studies show that women with recurrent urinary tract infections (UTI) want a greater emphasis on prevention and a structured treatment plan that promotes self-management. Our aim was to develop an evidence-based conceptual framework for a digital platform for the management of acute UTI symptoms and the prevention of future episodes in women with recurrent UTI.

Methods: Adult women diagnosed with recurrent UTIs were recruited from urogynecology and urology practices at a single institution. Exclusion criteria included patients with a diagnosis of bladder pain syndrome or chronic pelvic pain, on continuous antibiotics, on chronic immunosuppression, currently pregnant, and those who chronically self-catheterize. Findings from focus group studies and evidenced-based management strategies for recurrent UTI were integrated to develop a prototype texting platform that was patient-centered, HIPAA-compliant, and integrated with the patient’s electronic health record. Iterative rounds of rapid cycle innovation technique (contextual inquiry, feedback, analysis, and modification) were employed until engagement ≥ 85% and accuracy ≥ 80% were achieved. Participants provided qualitative feedback after using the platform through exit interviews. Patients also completed the System Usability Scale (SUS) that assesses the feasibility and learnability of digital health technology (68% score = 50th percentile, > 80% score = excellent usability).

Results: Thirty-one women with recurrent UTIs participated in testing over four months. The median age of patients was 71 years (interquartile range (IQR): 60-74). Most participants identified as White (83.9%). After engaging with the prototype platform, the median SUS score was 97.5% (IQR 87.5-100), indicating excellent usability. Qualitative feedback indicated that patients value fast access to information that helps them determine if antibiotic treatment is needed and brief, but engaging, videos about prevention (Table 1). Incorporating this feedback iteratively, a conceptual framework for the management of recurrent UTI was developed. This framework includes three main components: a symptom-based triage algorithm for acute UTI symptoms, short education videos on evidence-based prevention strategies, and weekly support messages to remind patients to use their prevention method (Figure 1). In this framework, symptoms reported in the triage algorithm are used to stratify patients into high, medium, and low probability of UTI to inform management decisions (urine culture and empiric antibiotics for the high probability group, urine culture and shared decision-making regarding antibiotics for the medium probability group, and no testing or antibiotics for the low probability group). Proposed metrics for testing the framework include the rate of unnecessary antibiotics, patient satisfaction and self-efficacy, and healthcare utilization.

Conclusions: A texting platform can be used to deliver evidence-based management of acute UTI symptoms and provide education and support for prevention of future episodes for women with recurrent UTIs. The proposed metrics could be used to test this conceptual framework in future clinical trials.