Presentation Authors: Taylor Y. Sadun*, Victoria C.S. Scott, Los Angeles, CA, Lauren W. Thum, Sioux Falls, SD, Melissa Markowitz, Los Angeles, CA, Sally L. Maliski, Kansas City, KS, Ja-Hong Kim, Jennifer T. Anger, Los Angeles, CA
Introduction: Much research has focused on the pathophysiology of urinary tract infections (UTIs). However, insight into patient perspective and impact of recurrent UTIs (rUTIs) on quality of life (QoL) is sparse. The objective of this study was to identify discrepancies in patient and physician perspectives of care provided to patients with rUTIs with the hope of improving the quality of care.
Methods: Patient perspectives were obtained by recruiting women with rUTIs (n=29) to small focus group discussions regarding knowledge, prevention strategies, treatment with antibiotics and alternatives, and impact on QoL. Physician perspectives were obtained, blinded to focus group discussion results, through interviews with experts specializing in UTI management. Qualitative analysis was performed using grounded theory methods as described by Charmaz. Themes developed by independent coders were compared and contrasted.
Results: Analysis of transcripts produced three predominant themes. First, patients were fearful of undertreated acute infections due to miscommunication with primary care providers, adverse effects from antibiotic usage, and rUTIs as a harbinger of larger underlying disease. Physicians also noted patient fear associated with rUTI; they augmented rUTI management with imaging and procedures to evaluate for undiagnosed morbidities associated with UTIs and engaged in extensive counseling. Second, while patients with rUTIs were more focused on improving care for acute UTIs, physicians were conversely more focused on prophylaxis and efficacious management of a chronic condition. Third, while patients reported resentment and frustration with the management of both their acute and rUTIs, physicians paradoxically believed that their patients were overall satisfied with their care.
Conclusions: Patient focus group discussions and physician interviews demonstrated the importance of addressing patient fear of rUTIs through specialty diagnostics and counseling by experts. Referral to UTI specialist allowed for more detailed evaluation of a patient&[prime]s history of bladder, bowel, and pelvic floor dysfunction; attention to antibiotic stewardship; and shared decision making. Analysis revealed that patients focus more on acute infections, while expert physicians focus on the chronic condition. This may explain the discrepancy in perceived satisfaction between the patient and treating physicians and highlight the need to improve current UTI management through patient education and expected treatment outcomes.