Primary care practitioners' experiences managing urinary tract infections: a qualitative evidence synthesis

Urinary tract infections (UTIs) are common in primary care. Qualitative studies suggest that the way primary care practitioners (PCPs) manage UTIs may be influenced by a complex interplay of factors.

To explore the views, perceptions, and experiences of PCPs in the management of UTIs.

Qualitative evidence synthesis of studies set in general practice internationally.

Four databases were systematically searched from inception to 28 June 2024, and forward citation searching of included studies was undertaken. Braun and Clarke's reflexive thematic analysis was used to synthesise findings and the Critical Appraisal Skills Programme (CASP) checklist was applied to assess the quality of studies.

In total, 3956 records were identified and 190 publications reviewed in full. Thirty-two qualitative studies reporting on 677 PCPs were included, generating the following themes: 1) I am confident; 2) … until patient X presents; 3) I am a victim of an overstretched healthcare system; 4) I must weigh up the benefits and impact of antibiotic treatment; and 5) it all comes down to our relationship. Using the CASP checklist, the quality of research was rated as high.

PCPs felt confident in managing UTIs, but uncertainty arose when patient X (children, men, older patients, those with recurrent UTIs) presented and PCPs perceived consultations as more complex. This analysis highlights the persistent and complex clinical challenge of assessing the risks and benefits of prescribing antibiotics. Chronic underfunding, staff shortages, and conflicting provider-patient expectations further complicated care, particularly when patients fall outside the ordinary (patient X).