Optimizing antimicrobial stewardship in urology: a qualitative study on needs, values and requirements for clinical...

Urinary tract infections (UTIs) are an important driver of antimicrobial use. Despite antimicrobial stewardship (AMS) initiatives, adherence to treatment guidelines remains poor. Clinical decision support systems (CDSSs) may enhance this, but require alignment with user needs for uptake.

To explore the experiences, challenges and support needs of urologists in UTI management to identify design requirements for AMS-related CDSSs.

A qualitative focus group study was conducted among physicians at a Dutch teaching hospital. During two sessions, diagnostic and treatment challenges were explored to elicit motivations for AMS and requirements for decision support. A multi-disciplinary research team used thematic analysis and requirements mapping methods for analysis.

Participants face multi-faceted challenges in infection treatment, mainly due to missing data and insufficient knowledge, leading to uncertainty in treatment choices. They expressed a need for support, motivated by the desire to improve patient care and increase workflow efficiency, and by the notion to consider antimicrobial resistance (AMR) in prescribing practices. Values for the design of CDSSs are quality of care, efficiency and professional autonomy, translated into requirements for functional properties, user experience and integration into the organizational structure.

Optimizing infection treatment requires an approach that balances effective individual antimicrobial therapy with public health priorities, such as AMR reduction. CDSSs can provide valuable support in this regard, provided that development and implementation are designed with clinical relevance, ease of use, and legal accountability in mind. Addressing the challenges and integrating the requirements from this study into CDSS development helps to create a sustainable and effective AMS strategy.