Qualitative Analysis of Primary Care Provider Prescribing Decisions for Urinary Tract Infections.

Larissa Grigoryan,Barbara W Trautner,Fareed M Khan,Lindsey Martin,Roger Zoorob,George J Germanos,Matthew S Horsfield,Susan Nash

doi:10.3390/antibiotics8020084

Larissa Grigoryan, Barbara W Trautner + Show 6 more

Open Access

https://doi.org/10.3390/antibiotics8020084

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Abstract

Inappropriate choices and durations of therapy for urinary tract infections (UTI) are a common and widespread problem. In this qualitative study, we sought to understand why primary care providers (PCPs) choose certain antibiotics or durations of treatment and the sources of information they rely upon to guide antibiotic-prescribing decisions. We conducted semi-structured interviews with 18 PCPs in two family medicine clinics focused on antibiotic-prescribing decisions for UTIs. Our interview guide focused on awareness and familiarity with guidelines (knowledge), acceptance and outcome expectancy (attitudes), and external barriers. We followed a six-phase approach to thematic analysis, finding that many PCPs believe that fluoroquinolones achieve more a rapid and effective control of UTI symptoms than trimethoprim-sulfamethoxazole or nitrofurantoin. Most providers were unfamiliar with fosfomycin as a possible first-line agent for the treatment of acute cystitis. PCPs may be misled by advanced patient age, diabetes, and recurrent UTIs to make inappropriate choices for the treatment of acute cystitis. For support in clinical decision making, few providers relied on guidelines, preferring instead to have decision support embedded in the electronic medical record. Knowing the PCPs’ knowledge gaps and preferred sources of information will guide the development of a primary care-specific antibiotic stewardship intervention for acute cystitis.

Highlights

Antimicrobial resistance is increasingly being recognized as one of the major threats to human health globally [1]
We interviewed 18 primary care providers working in two private academically affiliated
Most providers were unfamiliar with fosfomycin as a possible treatment option for cystitis, it is a first-line agent per guidelines [8]

Summary

Introduction

Antimicrobial resistance is increasingly being recognized as one of the major threats to human health globally [1]. Resistant Bacteria set a goal to reduce inappropriate antibiotic use by 50% in outpatient settings [2]. Primary care providers (PCPs) constitute the largest proportion of antibiotic prescribers in the U.S.; engaging these practitioners is essential to improving outpatient antibiotic stewardship [3]. In 2011, outpatient healthcare providers in the U.S prescribed 262.5 million courses of antibiotics, with the largest proportion (24%) being prescribed by family medicine physicians [3]. Most studies in outpatient settings have addressed implementing antibiotic stewardship for upper respiratory infections, typically viral infections in which antibiotics are not indicated [4,5]. Few studies have addressed inappropriately prescribing for urinary tract infections (UTI) [6], one of the top three diagnoses for which antibiotics are prescribed in outpatient settings [7].

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Conclusion