What are the knowledge, needs, and practices of GPs in the diagnosis and management of urinary tract infections?

Problem

Urinary tract infections are among the most common infections in primary care. Previous research showed that GPs frequently divert from guidelines in their diagnostics and antibiotics management. Perspectives of GPs are crucial when designing effective interventions that change their behavior and that of patients. We therefore aimed to investigate knowledge, needs, and practice of Dutch GPs towards UTIs during out-of-hours and regular hours care.

Approach

We conducted a cross-sectional internet-based survey among Dutch GPs between December 2021 and February 2022, using Qualtrics software. GPs were contacted profession affiliated newsletters and various social media platforms. Descriptive statistics and regression analyses were used to analyze the results in SPSS.

Findings

A total of 200 GPs were included. We asked GPs to choose two symptoms out of a list of nine that are most likely to indicate a UTI. Of all respondents, only nine GPs (4.5%) were able to choose the correct combination of dysuria and absence of vaginal complaints in women. One in three GPs would diagnose a UTI based on a-specific complaints and a positive leukocyte and erythrocyte test. Looking at current needs GPs indicated that improved diagnostics are most abundant during regular hours (48.6%) and out-of-hours (40.1%). Seven out of ten GPs indicated that better point-of-care diagnostics would aid them in prescribing antibiotics in a more justified manner (71%) and that it would conserve time during daily practice (69.5%). A positive test result is also the most important factor (55.5%) according to GPs to prescribe antibiotics while strikingly patients’ expectation is least important (86.5%). In addition, 65% of the GPs indicated they are more likely to prescribe antibiotics during out-of-hours care because of a lacking long-term relationship with patients.

Consequences

Diverting from guidelines in diagnoses and management of UTIs in general practice can likely be explained by a lack of knowledge among GPs. Only one out of twenty GPs knew the correct combination of symptoms that have the highest predictive value for having a UTI in women. In addition, there is an urgent need for better point-of-care diagnostics thereby saving time but also because a positive test finding is the most important factor for GPs to prescribe antibiotics. Despite of the fact that current dipstick tests have a very limited diagnostic value. More in depth research is needed to explore what makes GPs more prone to apply a wait-and-see policy. It should also focus on how we can improve informed decision-making since this will likely improve adherence to therapy and willingness to consider non-antibiotic treatment. Although UTIs are among the most common infections in primary care, there is still major need for improvement.