Peter K Kurotschka, Juliane Hemkeppler, David Gierszewski, Luca Ghirotto, Ildikó Gágyor
{"title":"探索全科医生在管理无并发症尿路感染妇女时的决策:一项定性研究。","authors":"Peter K Kurotschka, Juliane Hemkeppler, David Gierszewski, Luca Ghirotto, Ildikó Gágyor","doi":"10.3399/BJGPO.2023.0224","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>To be effective, interventions aimed at increasing the appropriateness of antibiotic use in primary care should consider the perspectives of prescribing physicians.</p><p><strong>Aim: </strong>To explore the decision making of general practitioners (GPs) when managing uncomplicated urinary tract infections (uUTIs) in women.</p><p><strong>Design & setting: </strong>A qualitative study using semi-structured interviews with 22 GPs in Bavaria and Baden-Württemberg (southern Germany).</p><p><strong>Method: </strong>Verbatim transcripts were analysed through inductive qualitative content analysis.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5000,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523529/pdf/","citationCount":"0","resultStr":"{\"title\":\"General practitioners' decision making managing uncomplicated urinary tract infections in women: a qualitative study.\",\"authors\":\"Peter K Kurotschka, Juliane Hemkeppler, David Gierszewski, Luca Ghirotto, Ildikó Gágyor\",\"doi\":\"10.3399/BJGPO.2023.0224\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>To be effective, interventions aimed at increasing the appropriateness of antibiotic use in primary care should consider the perspectives of prescribing physicians.</p><p><strong>Aim: </strong>To explore the decision making of general practitioners (GPs) when managing uncomplicated urinary tract infections (uUTIs) in women.</p><p><strong>Design & setting: </strong>A qualitative study using semi-structured interviews with 22 GPs in Bavaria and Baden-Württemberg (southern Germany).</p><p><strong>Method: </strong>Verbatim transcripts were analysed through inductive qualitative content analysis.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":36541,\"journal\":{\"name\":\"BJGP Open\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2024-10-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523529/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BJGP Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3399/BJGPO.2023.0224\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/10/1 0:00:00\",\"PubModel\":\"Print\",\"JCR\":\"Q2\",\"JCRName\":\"PRIMARY HEALTH CARE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BJGP Open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3399/BJGPO.2023.0224","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/1 0:00:00","PubModel":"Print","JCR":"Q2","JCRName":"PRIMARY HEALTH CARE","Score":null,"Total":0}
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 Baden-Württemberg (southern Germany).
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.