Exploring general practitioners' decision-making in the management of women with uncomplicated urinary tract infections: a qualitative study

Peter K Kurotschka; Juliane Hemkeppler; David Gierszewski; Luca Ghirotto; Ildikó Gágyor

doi:10.3399/BJGPO.2023.0224

Exploring general practitioners' decision-making in the management of women with uncomplicated urinary tract infections: a qualitative study

BJGP Open. 2024 Feb 29:BJGPO.2023.0224. doi: 10.3399/BJGPO.2023.0224. Online ahead of print.

Authors

Peter K Kurotschka¹, Juliane Hemkeppler², David Gierszewski², Luca Ghirotto³, Ildikó Gágyor²

Affiliations

¹ Department of General Practice, University Hospital Wurzburg, Wurzburg, Germany kurotschka_p@ukw.de.
² Department of General Practice, University Hospital Wurzburg, Wurzburg, Germany.
³ Qualitative Research Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.

PMID: 38423622
DOI: 10.3399/BJGPO.2023.0224

Abstract

Background: To be effective, interventions aiming at increasing the appropriateness of antibiotic use in primary care should consider the perspectives of prescribing physicians.

Aim: To explore the decision-making of general practitioners (GPs) when managing uncomplicated urinary tract infections (uUTIs) in women.

Design & setting: Semi-structured interviews with 22 GPs in Bavaria and Baden-Wurttemberg (southern Germany).

Method: Verbatim transcripts analysed through inductive qualitative content analysis.

Results: We generated three main themes: factors facilitating the decision-making, factors complicating the decision-making, and consultation modalities. According to participants, following evidence-based recommendations makes the prescription decision smoother. GPs' and patients' prior experiences and beliefs guides decisions towards certain antibiotics, even if those experiences and beliefs contradict evidence-based recommendations. Patient expectations and demands also conditions antibiotic prescribing, favouring it. Organisational constraints like time pressure, the day of the week (eg, before weekends) and a lower cost of antibiotics for patients than alternative treatments favour the decision to prescribe antibiotics. Diagnostic and prognostic uncertainty complicates decision-making, as does scepticism towards evidence-based recommendations. Discordance within the patient-doctor relationship contributed to this complexity. Regarding consultation modalities, a more in-depth consultation, and shared decision-making were seen as helpful in this process.

Conclusion: We identified different factors as intervening against or for a straightforward management decision when dealing with women with uUTIs. They reveal the complexity behind the GPs' decision-making. Providing GPs with easy-to-apply guidance while removing economic constraints to allocate sufficient consultation time, and supporting shared decision-making may help GPs appropriately manage uUTIs in women.

Keywords: Family medicine; Prescribing; Qualitative research.