General practitioners' decision making managing uncomplicated urinary tract infections in women: a qualitative study

Background: To be effective, interventions aimed at increasing the appropriateness of antibiotic use in primary care should consider the perspectives of prescribing physicians. Aim: To explore the decision making of general practitioners (GPs) when managing uncomplicated urinary tract infections (uUTIs) in women. Design & setting: A qualitative study using semi- structured interviews with 22 GPs in Bavaria and Method: Verbatim transcripts were analysed through inductive qualitative content analysis. Results: We generated the following three main themes: factors facilitating the decision making; factors complicating the decision making; and consultation modalities. According to participants, following evidence- based recommendations makes the prescription decision smoother. GPs' and patients' prior experiences and beliefs guides decisions towards certain antibiotics, even if those experiences and beliefs contradict evidence- based recommendations. Patient expectations and demands also condition antibiotic prescribing, favouring it. Organisational constraints, such as time pressure, the day of the week (for example, before weekends), and a lower cost of antibiotics for patients than alternative treatments favour the decision to prescribe antibiotics. Diagnostic and prognostic uncertainty complicates decision making, as does scepticism towards evidence- based recommendations. Discordance within the patient-doctor relationship contributed to this complexity. Regarding consultation modalities, a more in- depth consultation and shared decision making were seen as helpful in this process. Conclusion: We identified different factors as intervening against or for a straightforward management decision when dealing with women with uUTIs. They reveal the complexity behind the GPs' decision making. Providing GPs with easy- to- apply guidance while removing economic constraints to allocate sufficient consultation time, and supporting shared decision making may help GPs appropriately manage uUTIs in women.