Womens' self‐management skills for prevention and treatment of recurring urinary tract infection

Zande, Rian Lelie-van der; Koster, Ellen S.; Teichert, Martina; Bouvy, Marcel L.

doi:10.1111/ijcp.14289

Cited by 14 publications

(16 citation statements)

References 28 publications

(52 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[17] In East Africa, high community prevalence of UTIs, combined with high levels of AB self-medication, may further exacerbate ABR, [14] particularly considering self-management for UTI symptoms is extremely common. [18,19]…”

Section: Introductionmentioning

confidence: 99%

Unravelling patient pathways in the context of antibacterial resistance in East Africa

Keenan

Fredricks

Ahad

et al. 2022

Preprint

View full text Add to dashboard Cite

Background A key factor driving the development and maintenance of antibacterial resistance (ABR) is individuals’ use of antibiotics (ABs) to treat illness. It is therefore crucial to understand the dynamics of patient treatment-seeking - where patients go when unwell, what motivates choice, and treatments they obtain. Developing a better understanding of social inequalities of antibiotic use in low resource settings has been identified as a research priority, as has understanding pluralistic healthcare landscapes, but so far robust multi-country mixed methods data has been lacking. This paper aims to investigate patterns and determinants of patient treatment-seeking pathways, and how they intersect with AB use in East Africa, a region where ABR-attributable deaths are exceptionally high. MethodsThe Holistic Approach to Unravelling Antimicrobial Resistance (HATUA) Consortium collected quantitative data from 6,827 adult outpatients presenting with urinary tract infection (UTI) symptoms in Kenya, Tanzania, and Uganda, and conducted qualitative in-depth patient interviews with a subset (n=116). We described patterns of treatment-seeking visually using Sankey plots and elucidated explanations using mixed-methods. Using Bayesian hierarchical regression modelling, we investigated the associations between socio-demographic, economic, healthcare, and attitudinal factors and three outcomes related to ABR: self-treatment as a first step, having a multi-step treatment pathway, and consuming ABs.ResultsDespite patients predominantly seeking help from medical facilities as a first step, many described complex and repetitive treatment-seeking pathways, which increased the likelihood of consuming ABs. Higher socio-economic status patients were more likely to consume ABs and multi-step pathways. Reasons for choosing providers (e.g., cost, location, time) were conditioned by wider structural factors such as healthcare systems and AB availability.Conclusion There is likely to be a reinforcing cycle between complex, repetitive treatment pathways, AB consumption and ABR, which could become more common as ABR evolves. A focus on individual behaviours obscures the contextual challenges patients face when treatment seeking. Pluralistic healthcare landscapes may promote more complex treatment seeking and therefore inappropriate AB use. We recommend intervening on aspects of the treatment cycle amenable to change, focussing on medical facilities (e.g., accessible diagnostics, patient-doctor interactions, information flows), and community AB access points (e.g., drug sellers).

show abstract

Section: Introductionmentioning

confidence: 99%

Unravelling patient pathways in the context of antibacterial resistance in East Africa

Keenan

Fredricks

Ahad

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…These perspectives could be relevant since at least 10% of the GPs reported they would prescribe antibiotics at patients’ request. Moreover, patients who have experience with UTIs could have multiple motivations for requesting urine tests, such as fear of a complicated UTI [ 33 , 34 ]. With regard to antibiotic stewardship, it could also be interesting to focus more on non-antibiotic alternatives to treat symptomatic UTIs [ 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Guideline Adherence of Asymptomatic Bacteriuria Could Be Improved among General Practitioners in The Netherlands: A Survey Study

et al. 2022

View full text Add to dashboard Cite

Asymptomatic bacteriuria (ASB) is a common finding in certain populations. This study assessed general practitioners’ (GPs’) knowledge about ASB and their current clinical practice regarding urine testing. Methods: An online survey was used for GPs in the Netherlands from October to December 2020. Results: In total, 99 surveys were included in the analyses. All GPs strongly agreed with the statements about their knowledge and self-confidence regarding urine diagnostics and treatment of ASB. The median knowledge score was 4 out of 6 (IQR 2 to 6). Most GPs (64 of 92; 70%) followed the guideline for the choice of urine diagnostics and reported appropriate indications for urine testing. However, 71/94 (75.5%) GPs would treat patients for ASB if they have diabetes mellitus. Further, 34 (37%) of 92 participants would inappropriately repeat a urine test after a patient was treated for a urinary tract infection (UTI). One-third of the GPs responded that ASB was insufficiently addressed within the guidelines for UTI. Conclusion: These results indicate that knowledge about ASB could be improved in primary care in the Netherlands, mainly in diabetic patients that have ASB, as well as for follow-up tests after treatment for UTI.

show abstract

“…Further, most women with a history of cystitis in our study had gained information as a result of their experience with cystitis, which was also found in previously performed qualitative studies. The results of these studies showed a large variation in patient knowledge about UTIs and prophylactic strategies for recurring UTIs [ 30 , 32 ]. Especially women in our study who had experienced pyelonephritis or other complicated UTIs indicated that they were afraid to develop this again when they had cystitis.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Womens' self‐management skills for prevention and treatment of recurring urinary tract infection

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 14 publications

References 28 publications

Unravelling patient pathways in the context of antibacterial resistance in East Africa

Unravelling patient pathways in the context of antibacterial resistance in East Africa

Guideline Adherence of Asymptomatic Bacteriuria Could Be Improved among General Practitioners in The Netherlands: A Survey Study

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

Contact Info

Product

Resources

About