Shared decision making for women with uncomplicated Cystitis in Primary Care in the Netherlands: a qualitative interview study

Abstract

Background Urinary tract infections (UTIs) are common, especially among women. Antibiotics are commonly used to treat UTIs, but might not always be necessary, for example in the case of uncomplicated UTIs such as cystitis. Shared decision making (SDM) could reduce the risk of unnecessary antibiotic prescriptions for uncomplicated cystitis. We investigated the current management and the use of SDM for uncomplicated cystitis in primary care. Methods We performed a qualitative semi-structured interview study among 23 women with a history of cystitis, 12 general practitioner (GP) assistants, and 12 GPs in the Netherlands from July to October 2020. All interviews were individually performed by telephone. The data were analyzed through the use of using open and axial coding. Results The GP assistants managed the initial diagnostics and treatment of uncomplicated cystitis in all general practices. Usually, antibiotics were considered the standard treatment of cystitis. In most general practices, SDM was not used in the treatment of uncomplicated cystitis, mainly because of a lack of time. Women reported that they valued being involved in the treatment decision-making process, but they were not always involved. Further, both GP assistants and GPs indicated that SDM would improve the care pathway of uncomplicated UTIs. Conclusion In our study, SDM was infrequently used to help women with uncomplicated cystitis. To reduce the use of antibiotics for uncomplicated UTIs, a tailored intervention is needed to implement SDM for the treatment of uncomplicated cystitis in primary care.

Patients’ Experiences, Expectations, Motivations, and Perspectives around Urinary Tract Infection Care in General Practice: A Qualitative Interview Study

“…Patients' preference for antibiotics arises from previous positive experiences [14], a reason mentioned frequently in our study. Therefore, we hypothesise that due to the previous treatments, patients link symptom reduction to antibiotics and consider them necessary to cure UTIs, a notion held by patients from previous studies [14][15][16]. This association needs to be broken in order for antibiotic prescribing for UTIs to change [17].…”

“…A complicating fact in this case is that the diagnostic tests currently available to GPs are either inaccurate (urinary dipstick) or time consuming (urinary culture) [27]. An accurate pointof-care test would make it much easier for GPs to correctly diagnose patient symptoms and could prevent overtreatment with antibiotics in patients with urinary symptoms and undertreatment in patients with any other conditions that might be at play [15,28,29].…”