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. 2019 Jun 19;8(2):84.
doi: 10.3390/antibiotics8020084.

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

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Free PMC article

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

Larissa Grigoryan et al. Antibiotics (Basel). .
Free PMC article

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.

Keywords: antibiotic stewardship; antibiotics; fluoroquinolones; guidelines; urinary tract infections.

Conflict of interest statement

Grigoryan and Trautner report grants from the National Institutes of Health and the U.S. Department of Veterans Affairs Health Services Research & Development Service.

Figures

Figure 1
Figure 1
Mapping of the identified themes to the Cabana framework.
Figure 2
Figure 2
Sample interview questions.

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