The following is a summary of “U.S. Primary Care Physician Perceptions on Barriers to Providing Guideline-driven Care for UTI and Recurrent UTI: A Qualitative Study,” published in the July 2024 issue of Primary Care by Park et al.
Urinary tract infections (UTIs) affect nearly two-thirds of women at some point in their lives, with many experiencing recurrent infections. Despite the existence of evidence-based guidelines from various international organizations for evaluating and treating UTIs and recurrent UTIs (rUTIs), recent analyses of claims data reveal a concerning lack of adherence to these guidelines among healthcare providers. This study aims to elucidate the barriers U.S. primary care providers (PCPs) face in delivering guideline-based care for UTIs and rUTIs.
Researchers conducted semi-structured interviews with 18 PCPs from the greater Los Angeles area to achieve this. They explored their real-world management of UTI and rUTI episodes, referral practices to subspecialty care, and the resources that inform their counseling and treatment strategies. Using grounded theory methodology, they analyzed the interview transcripts to identify preliminary and overarching themes.
The results indicated that while participants strongly preferred obtaining urine cultures for each cystitis episode, they frequently felt pressured to compromise due to patient demands or systemic barriers to care. PCPs exhibited lower thresholds for initiating empirical treatment, particularly for patients with a history of rUTIs, elderly individuals, or those reluctant to undergo further evaluation. Laboratory data were underutilized in clinical decision-making; urinalyses were rarely considered when interpreting culture results. Moreover, PCPs often conflated a wide range of urologic and non-urologic symptoms with UTIs, even in cases of negative cultures. Many providers reported discomfort with initiating UTI prophylaxis, opting instead to seek specialist evaluations for potential anatomical issues. Furthermore, they expressed a lack of familiarity with management guidelines, often relying on UpToDate® as their primary resource, which resulted in limited recommendations for evidence-based UTI prevention interventions.
In conclusion, the need for clearer and more concise professional guidelines presents significant barriers to effective UTI and rUTI management. The poor usability of clinical guidance documents contributes to widespread confusion regarding preventative measures and the necessity for additional diagnostic testing. Additionally, patient access to care challenges lead to presumptive treatment expectations. Future research is warranted to assess whether improved educational materials for providers and management algorithms can enhance adherence to guidelines in managing UTIs.
Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-024-02477-3
