Empowerment Program to Reduce Treatment of Asymptomatic Bacteriuria in Veterans With Spinal Cord Injury

Antimicrobial resistance is a major public health concern that worsens healthcare outcomes. Antibiotic resistant organisms occur more often in Veterans with spinal cord injury or disease (SCI/D) given their frequent exposure to antibiotics, recurrent hospitalizations, and common use of urinary catheter devices. Veterans with SCI/D are also at risk for overtreatment with antibiotics when they do not need them, particularly for over-diagnosed urinary tract infections. The investigators plan to create a patient empowerment program with input of Veterans with SCI/D \[and their providers\] to help guide their decisions and next steps when they have a change in bladder symptoms. The program will give Veterans with SCI/D the tools to speak up to their provider and advocate for themselves to avoid receiving unnecessary antibiotics. This program is highly innovative, as it puts Veterans with SCI/D in charge of thoughtful antibiotic use, or antibiotic stewardship.

Inclusion Criteria: * Veterans with SCI/D and neurogenic bladders who have been treated for at least one UTI in the past year * Have access to a telephone * Have not been involved in the development phase of the program Exclusion Criteria: * Non-Veterans * Veterans without SCI/D or neurogenic bladder * Patients with dementia who would not be able to provide consent or respond to interview prompts * Patients who do not receive primary care at the MEDVAMC * Veterans who participated in the development of the empowerment program