Diagnosis and Management of UTI in Primary Care Settings-A Qualitative Study to Inform a Diagnostic Quick Reference Tool for Women Under 65 Years

Emily Cooper; Leah Jones; Annie Joseph; Rosie Allison; Natalie Gold; James Larcombe; Philippa Moore; Cliodna A M McNulty

doi:10.3390/antibiotics9090581

Diagnosis and Management of UTI in Primary Care Settings-A Qualitative Study to Inform a Diagnostic Quick Reference Tool for Women Under 65 Years

Antibiotics (Basel). 2020 Sep 7;9(9):581. doi: 10.3390/antibiotics9090581.

Authors

Emily Cooper¹, Leah Jones¹, Annie Joseph², Rosie Allison¹, Natalie Gold³, James Larcombe⁴, Philippa Moore⁵, Cliodna A M McNulty¹

Affiliations

¹ Primary Care and Interventions Unit, Public Health England, Twyver House, Bruton Way, Gloucester GL1 1DQ, UK.
² Nottingham University Hospitals, Hucknall Rd, Nottingham NG5 1PB, UK.
³ Public Health England Behaviour Insights (PHEBI) Team and University of Oxford, Wellington Square, Oxford OX1 2JD, UK.
⁴ General Practitioner, County Durham, UK.
⁵ Gloucestershire Hospitals National Health Service Foundation Trust, Great Western Rd, Gloucester GL1 3NN, UK.

Abstract

Background: To inform interventions to improve antimicrobial use in urinary tract infections (UTIs) and contribute to a reduction in Escherichia coli bloodstream infection, we explored factors influencing the diagnosis and management of UTIs in primary care. Design: Semi-structured focus groups informed by the Theoretical Domains Framework. Setting: General practice (GP) surgeries in two English clinical commissioning groups (CCGs), June 2017 to March 2018. Participants: A total of 57 GP staff within 8 focus groups. Results: Staff were very aware of common UTI symptoms and nitrofurantoin as first-line treatment, but some were less aware about when to send a urine culture, second-line and non-antibiotic management, and did not probe for signs and symptoms to specifically exclude vaginal causes or pyelonephritis before prescribing. Many consultations were undertaken over the phone, many by nurse practitioners, and followed established protocols that often included urine dipsticks and receptionists. Patient expectations increased use of urine dipsticks, and immediate and 5 days courses of antibiotics. Management decisions were also influenced by patient co-morbidities. No participants had undertaken recent UTI audits. Patient discussions around antibiotic resistance and back-up antibiotics were uncommon compared to consultations for respiratory infections. Conclusions: Knowledge and skill gaps could be addressed with education and clear, accessible, UTI diagnostic and management guidance and protocols that are also appropriate for phone consultations. Public antibiotic campaigns and patient-facing information should cover UTIs, non-pharmaceutical recommendations for "self-care", prevention and rationale for 3 days antibiotic courses. Practices should be encouraged to audit UTI management.

Keywords: BSI; EBSI; Escherichia coli bloodstream infection; antibiotic prescribing; antibiotics; antimicrobial resistance; behavioural science; bloodstream infection; delayed prescribing; diagnostic; expectations; general practice; knowledge; pyelonephritis; questionnaire; survey.