GPs’ perspectives on diagnosing childhood urinary tract infections: a qualitative study

Abstract

Background: Diagnosis and management of childhood urinary tract infections (UTI) is challenging in general practice, because of a range of factors. Aim: To explore general practitioners’ perspectives concerning the barriers and facilitators for diagnosis and management of childhood UTI. Design and setting: Qualitative study in general practice, Belgium. Method: Semi-structured interviews with 23 general practitioners from January 2021 to June 2021. Interviews were video- and audio recorded, transcribed verbatim and analyzed using a thematic approach. Results: The barriers for early diagnosis of UTI were the assumption of low UTI prevalence and aspecific presentation of UTI in children, difficulties in urine collection, and diagnostic uncertainty. All GPs indicated they sampled urine in either children with specific UTI features (dysuria, abdominal pain), or unexplained fever. Facilitators for UTI screening were instructional material for parents, skill training for GPs, additional nursing staff, novel noninvasive convenient collection methods, online decision support informing parents when to bring a urine sample to the consultation and an accurate easy-to-use point-of-care test for UTI. Empirical antibiotic treatment was initiated based on dipstick test results, clinical features suggestive of UTI, severity of illness, gut feeling, long duration of fever, time of the day and parents’ ability to judge disease severity. Conclusion: The assumption of a low UTI prevalence, absence of obvious UTI features and difficult urine sampling might cause childhood UTIs to go undetected in general practice. Diagnostic uncertainty makes appropriate treatment challenging.

Clinician and parent views on urine collection in precontinent children in the UK: a qualitative interview study

“…Our findings also demonstrate the need for improved urine collection methods, such as a device which could make the urine collection process less challenging for parents and less distressing for the children. Previous literature, detailing the strengths and shortcomings of various methods of urine collection, including all of those discussed in our study, also points towards the need for new methods 2 4 11…”

“…While there is evidence that quicker sample collection can occur by the ‘Quick-Wee’ method,16 acceleration methods did not appear to be routinely practised by the HCPs we interviewed, as they required a number of staff members to be involved,17 and parents were typically not informed about them. Although GPs who had tried this method considered it impractical, such information could potentially improve the urine collection process for parents 2. Parents would have appreciated clearer communication from HCPs about why a urine sample is necessary and they often expressed the need for more information and support for collecting urine samples, as these may determine the management of their child’s illness.…”

“…Urinary tract infections (UTIs) are common bacterial infections in young children 1. Diagnosis is challenging as symptoms typical of UTI in adults may be absent 2. In one study, fewer than one-third of children who presented to primary care with acute illness and met microbiological criteria for UTI had been clinically suspected of having a UTI 3.…”