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Article

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

1
Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098, USA
2
Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA
3
Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
*
Author to whom correspondence should be addressed.
Antibiotics 2019, 8(2), 84; https://doi.org/10.3390/antibiotics8020084
Received: 14 May 2019 / Revised: 13 June 2019 / Accepted: 14 June 2019 / Published: 19 June 2019
(This article belongs to the Special Issue Feature Paper in Antibiotics for 2019)
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. View Full-Text
Keywords: antibiotic stewardship; antibiotics; fluoroquinolones; guidelines; urinary tract infections antibiotic stewardship; antibiotics; fluoroquinolones; guidelines; urinary tract infections
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MDPI and ACS Style

Grigoryan, L.; Nash, S.; Zoorob, R.; Germanos, G.J.; Horsfield, M.S.; Khan, F.M.; Martin, L.; Trautner, B.W. Qualitative Analysis of Primary Care Provider Prescribing Decisions for Urinary Tract Infections. Antibiotics 2019, 8, 84. https://doi.org/10.3390/antibiotics8020084

AMA Style

Grigoryan L, Nash S, Zoorob R, Germanos GJ, Horsfield MS, Khan FM, Martin L, Trautner BW. Qualitative Analysis of Primary Care Provider Prescribing Decisions for Urinary Tract Infections. Antibiotics. 2019; 8(2):84. https://doi.org/10.3390/antibiotics8020084

Chicago/Turabian Style

Grigoryan, Larissa, Susan Nash, Roger Zoorob, George J. Germanos, Matthew S. Horsfield, Fareed M. Khan, Lindsey Martin, and Barbara W. Trautner. 2019. "Qualitative Analysis of Primary Care Provider Prescribing Decisions for Urinary Tract Infections" Antibiotics 8, no. 2: 84. https://doi.org/10.3390/antibiotics8020084

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