Diagnosis and management of uti in primary care settings—a qualitative study to inform a diagnostic quick reference tool for women under 65 years

Emily Cooper*, Leah Jones, Annie Joseph, Rosie Allison, Natalie Gold, James Larcombe, Philippa Moore, Cliodna McNulty

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    7 Citations (Scopus)


    Background: To inform interventions to improve antimicrobial use in urinary tract infections (UTIs) and contribute to a reduction in Escherichia coli bloodstream infection, we explored factors influencing the diagnosis and management of UTIs in primary care. Design: Semi-structured focus groups informed by the Theoretical Domains Framework. Setting: General practice (GP) surgeries in two English clinical commissioning groups (CCGs), June 2017 to March 2018. Participants: A total of 57 GP staff within 8 focus groups. Results: Staff were very aware of common UTI symptoms and nitrofurantoin as first-line treatment, but some were less aware about when to send a urine culture, second-line and non-antibiotic management, and did not probe for signs and symptoms to specifically exclude vaginal causes or pyelonephritis before prescribing. Many consultations were undertaken over the phone, many by nurse practitioners, and followed established protocols that often included urine dipsticks and receptionists. Patient expectations increased use of urine dipsticks, and immediate and 5 days courses of antibiotics. Management decisions were also influenced by patient co-morbidities. No participants had undertaken recent UTI audits. Patient discussions around antibiotic resistance and back-up antibiotics were uncommon compared to consultations for respiratory infections. Conclusions: Knowledge and skill gaps could be addressed with education and clear, accessible, UTI diagnostic and management guidance and protocols that are also appropriate for phone consultations. Public antibiotic campaigns and patient-facing information should cover UTIs, non-pharmaceutical recommendations for “self-care”, prevention and rationale for 3 days antibiotic courses. Practices should be encouraged to audit UTI management.

    Original languageEnglish
    Article number581
    Pages (from-to)1-18
    Number of pages18
    Issue number9
    Publication statusPublished - Sept 2020

    Bibliographical note

    Funding Information:
    Sarah Alton?Research Assistant, PCIU, Public Health England. Workshop participants that contributed to the development of the UTI diagnostic tool: Barry Sullman?GP and prescribing lead, Newham CCG/Chair of the NEL AMRSG; Elizabeth Beech?National Project Lead for Health Care Acquired Infection and Antimicrobial Resistance, NHS Improvement; Fran Husson?patient representative; Helen Moriarty?care home expert advisor, NHS Improvement; Ian Donald?Consultant in Old Age Medicine, Gloucester Royal/Stroud; Linda Dempster?Head of Infection Prevention and Control, NHS Improvement; Maninder Kaur Singh?Lead Prescribing Advisor, NHS Newham CCG; Maria Smith?Senior Pharmacist Advisor, Chiltern and Aylesbury Vale CCG; Mohamed Sadak?Clinical Lead and Programme Manager, Health Education England; Oge Chesa?Deputy Chief Pharmacist, Barking and Dagenham, Havering Redbridge Clinical Commissioning Groups; Sheela Swamy?Obstetrician and Gynecologist, UCL; Stephen Granier?RCGP representative and general practitioner; Steve Simmonds?NPA Representation Manager, Community Pharmacy Wales National Pharmacy Association; Wendy Gray?Head of Nursing, Lead for Excellence in Continence Caregroup?Regional Nursing Directorate NHS England; Anne Thomson?Lead Clinical Pharmacist, Glasgow City HSCP; Jacqueline Sneddon?Project Lead, Scottish Antimicrobial Prescribing Group; Lesley Shepherd?Nurse Consultant, Health Protection Scotland; William Malcolm?Pharmaceutical Advisor, Information Services Division Scotland.

    Publisher Copyright:
    © 2020 by the authors. Licensee MDPI, Basel, Switzerland.


    • Antibiotic prescribing
    • Antibiotics
    • Antimicrobial resistance
    • BSI
    • Behavioural science
    • Bloodstream infection
    • Delayed prescribing
    • Diagnostic
    • EBSI
    • Escherichia coli bloodstream infection
    • Expectations
    • General practice
    • Knowledge
    • Pyelonephritis
    • Questionnaire
    • Survey


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