Patient perspectives on the management of recurrent urinary tract infections

Objectives: We sought to understand factors important to patients in their decision-making for the management of recurrent urinary tract infections (UTI).

Methods: This was an institutional review board-approved qualitative study with focus groups in women with recurrent UTIs. Participants were recruited from urogynecology and urology practices at a single institution. Inclusion criteria were women aged 18 and older with the diagnosis of recurrent culture-proven UTIs. Prior to focus group participation, subjects filled out information about demographics, prior recurrent UTI treatment, and the Belief about Medicines Questionnaire (BMQ). The BMQ is a validated questionnaire that assesses patients’ beliefs about medications in general (harm and overuse subscales) and medications prescribed to them for a specific condition (necessity and concerns subscales). Four to five patients participated in each 90-minute focus group, which was moderated by a non-physician researcher. Descriptive statistics were used for participant characteristics and questionnaire data. Line-by-line coding of each focus group transcript by three independent physicians and NVivo software were used to develop emergent concepts and themes using Grounded Theory methodology.

Results: A total of 26 women participated in six focus groups. The average age of the subjects was 59 years (SD = 16) and 76.9% were post-menopausal (Table 1). Overall, 73.1% of subjects identified as White and 19.2% as Black or African American. The average age of diagnosis for recurrent UTIs was 45 years (SD = 17). Approximately 65% of women reported sexual activity in the last year and 39% reported a diagnosis of anxiety. All women were currently on or had already tried multiple prevention modalities for their recurrent UTIs, including lifestyle or behavioral measures, over-the-counter products, and prescription treatments. The average BMQ scores for a belief in harm and overuse of medicines in general were both low. The average BMQ necessity score was 17.3 (SD = 3.8) and concerns score was 12.8 (SD = 3.3), indicating a net positive attitude towards medicines prescribed for recurrent UTI prevention. Themes identified in the focus groups are listed in Table 2. First, patients want providers to acknowledge the high burden of bothersome symptoms and frequent contact with the healthcare system imposed by recurrent UTIs. Second, they want earlier diagnosis of their condition and early referral to a specialist. Third, they desire a greater emphasis on education and evidence-based prevention strategies to reduce the amount of antibiotics prescribed. Finally, they expressed a desire for self-management of their condition through a structured treatment plan with support from their providers.

Conclusions: Patients desire a greater emphasis on prevention and self-management for their recurrent UTIs. The findings of this study can help frame a patient-centered approach to the management of recurrent UTIs in primary care and specialty clinics.