´I am confident … until patient X presents´ – a qualitative meta-synthesis to understand primary healthcare professionals´ experience with urinary tract infections

Henrike Kleuser, Francine Toye, Luca Ghirotto, Sandra Parisi, Alice Serafini, Maria Chiara Bassi, Felix Kannapin, Johannes Liese, Ildikó Gagyór, Peter Kurotschka

Keywords: management of UTIs, qualitative research , meta-synthesis

Background:

Urinary tract infections (UTIs) are among the most common infections encountered in primary care. Qualitative research shows that numerous factors such as prior experiences, habits, patient expectations, time constraints, or available resources may influence how Primary Care Professionals (HCPs: physicians, nurses, and other healthcare professionals) manage UTIs. Gaining insight into their perspectives facilitates better healthcare provision.

Research questions:

What are the experiences of HCPs when managing patients with UTIs? What aspects do HCPs consider when treating adults and children with UTIs?

Method:

We systematically searched PubMed, Embase, PsycINFO, and CINAHL from inception to October 7th, 2022, to retrieve qualitative research focusing on HCPs´ experiences in UTI management. We synthesised findings of included studies using Braun and Clarke´s reflexive thematic analysis, and subsequently applied GRADE-CERQual to rate confidence in our findings. PROSPERO registration: CRD42022301250.

Results:

We retrieved 2794 records, reviewed 140 studies in full, and selected 20 studies from nine different countries reporting the experiences of 389 HCPs. The theme ´I am confident …until patient X presents´ illustrates that HCPs approached UTI consultations with a high level of confidence due to their familiarity and experience. However, confidence waned when particular groups of patients (children, recurrent UTIs, elderly patients, and male patients) presented. HCPs then reported uncertainty for initial diagnosis and treatment, fearing deterioration of symptoms and treatment failure. The theme ´I have to balance patient preferences and antimicrobial resistance´ describes that HCPs carefully weighed individual risk factors against the danger of increasing resistance, acting in the patients´ and communities´ best interest. ´I am a victim of an overstretched healthcare system´ describes how time-constraints, shortage of staff, limited resources, and reimbursement of consultations influenced the management of UTIs.

Conclusions:

HCPs are confident in managing UTIs until patients with non-specific symptoms present. Patient preferences, antimicrobial stewardship efforts and available resources influence the management of UTIs.

Points for discussion:

Looking at certain tasks assigned to medical personnel in your country: What responsibilities do GPs, nurses, receptionists etc. have in your country?

How do our findings match your experience in practice?

What patient groups do you find challenging and/or perceive to be complicated when managing UTIs?

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