Abstract
BackgroundUncomplicated urinary tract infection (uUTI) is very common among women in primary care. The risk of developing pyelonephritis remains low after uUTI, nonetheless, empiric antibiotic therapy is frequently prescribed for symptomatic purposes. This may lead to adverse effects and antibiotic resistance. Furthermore, patients may express the will to limit the use of antibiotics. Some European countries recommend discussing a delayed prescription with the patient and developing a shared decision. The aim of this study is to create a patient decision aid (PtDA) used in primary care settings to make a shared decision between practitioners and women about whether or not to treat uUTI with antibiotics.MethodsWe followed the steps recommended by the International Patient Decision Aids Standards, with a scoping phase, a design phase (including focus groups and literature review), and an alpha-testing phase. A steering group, made of patients and physicians, met throughout the study to develop a prototype PtDA.ResultsThe information included in the PtDA is the definition of uUTI, information on the options, their benefits, risks, and consequences, based on a review of the literature. The results of the focus group made possible to determine the patient’s values and preferences to consider in decision-making, including: the discomfort felt, the impact on daily life, patients’ perceptions of antibiotics, and the position relative to the risk of adverse effect. The choices in presentation, organisation and design are the result of the work of the steering group, improved by feedback from alpha testing. We confirmed the need for shared decision-making and the equipoise in this situation.ConclusionsWe developed a PtDA to be used in primary care for sharing decision on the use of antibiotic in uUTI. It needs to be validated in a beta-testing phase, with complementary advice from peers, and then tested in a clinical study comparing its use with the systematic prescription approach.
Highlights
Uncomplicated urinary tract infection is very common among women in primary care
The objective of this study is to develop a patient decision aid for shared decision-making for the treatment of Uncomplicated urinary tract infection (uUTI) in primary care setting
This literature review was updated by a third researcher (AF), targeting the outcomes identified by the steering group after the design phase and after the alpha-testing phase
Summary
Uncomplicated urinary tract infection (uUTI) is very common among women in primary care. The risk of developing pyelonephritis remains low after uUTI, empiric antibiotic therapy is frequently prescribed for symptomatic purposes. This may lead to adverse effects and antibiotic resistance. Uncomplicated urinary tract infection (uUTI), or cystitis, is among the leading reasons for infectious disease consultation in primary care [1]. Cystitis can resolve spontaneously [5] with a rare risk of pyelonephritis [6] In this context, some patients prefer either to discuss the advantages and disadvantages of antibiotics with their physicians [7] or even to avoid antibiotic uUTIs treatment [8]. This lead several authors to suggest a shared decision-making approach in uUTI [9, 10]
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