Primary Care Practitioners' Experiences Managing Urinary Tract Infections: A Qualitative Evidence Synthesis

Background: 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. Aim: To explore views, perceptions, and experiences of PCPs in the management of UTIs. Design and setting: Qualitative evidence synthesis of studies set in general practice. Methods: We systematically searched four databases from inception to June 28th, 2024 and performed forward citation searching of included studies. We synthesised findings using Braun and Clarke’s reflexive thematic analysis and applied the Critical Appraisal Skills Programme (CASP) to assess the quality of studies. Results: We identified 3,956 records and reviewed 190 reports in full. We included 32 qualitative studies reporting on 690 PCPs, 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 benefits and impact of antibiotic treatment, (5) It all comes down to our relationship. Using the CASP checklist, we rated the quality of research as high. Conclusion: PCPs felt confident in managing UTIs but uncertainty arose when patient X (children, males, older patients, recurrent UTIs) presented, and PCPs perceived consultations as more complex. Our 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).