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

Abstract

To be effective, interventions aiming at increasing the appropriateness of antibiotic use in primary care should consider the perspectives of prescribing physicians. To explore the decision-making of general practitioners (GPs) when managing uncomplicated urinary tract infections (uUTIs) in women. Semi-structured interviews with 22 GPs in Bavaria and Baden-Wurttemberg (southern Germany). Verbatim transcripts analysed through inductive qualitative content analysis. 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. 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.