Construction of a patient decision aid for the treatment of uncomplicated urinary tract infection in primary care

Polish Medical Doctors' Opinions on Available Resources and Information Campaigns concerning Antibiotics and Antibiotic Resistance, a Cross-Sectional Study

Background: Antibiotic resistance (ABR) is at the top of global health threats. This paper aims to assess Polish physicians' readiness to impact ABR through prescribing routines. Methods: Surveying Polish physicians participating in specialization courses at the Center for Postgraduate Medical Education in Warsaw, Poland from October 2019 to March 2020. Results: Information was obtained from 504 physicians aged 25-59, mean 32.8 ± 5.9 years, mainly women (65%). Most doctors (78%) prescribed antibiotics at least once a week. Physicians indicated clinical practice guidelines as resources most often consulted in the management of infections (90%). However, clinical experience was also declared a powerful resource. In total, 54% of respondents recalled receiving information about the prudent use of antibiotics within 12 months, which partially translated into changing views (56%) and practice (42%). Physicians disagreed that national campaigns provide good promotion of prudent antibiotics use (75%) or that they are effective (61%). Only 40% of doctors were aware of the national campaign promoting responsible antibiotics use, 24% had heard about the European Antibiotic Awareness Day and 20% knew about the World Antimicrobial Awareness Week. Conclusions: Prescribers most often rely on clinical practice guidelines and their own experience as resources for antibiotics use. Doctors' awareness of available resources and information campaigns concerning antibiotics and antibiotic resistance should be improved.

Decision aids linked to the recommendations in clinical practice guidelines: results of the acceptability of a decision aid for patients with generalized anxiety disorder

Background

Generalized anxiety disorder (GAD) is one of the most prevalent mental health problems. Patients with GAD have unmet needs related to the information received about their disorder, its treatments and their participation in the decision-making process. The aim of this study is to develop and assess the acceptability of a patient decision aid (PtDA) for patients with GAD.

Method

The PtDA was developed following the International Patient Decision Aid Standards. The recommendations of the Spanish clinical practice guideline (CPG) for patients with GAD were used as the basis. The first prototype was developed by an expert committee, further improvements were made with patients (n = 2), clinical experts (n = 13) and the project management group (n = 7). The acceptability of this second draft was assessed by patients non-involved in the previous phases (n = 11).

Results

The final PtDA version included a brief description of GAD and its treatments. Most participants agreed that the PtDA was easy to use, visually appealing and useful. At least half of the participants learned new things about treatments and adverse effects.

Conclusions

A PtDA was developed for patients with GAD based on recommendations from the Spanish CPG. It was improved and accepted by patients and clinical experts involved. An evaluation of its effectiveness on the shared decision-making process during the clinical encounter is planned.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-01899-2.

[Antibiotic resistance and antibiotic consumption in a region - using the example of community-acquired urinary tract infections]

BACKGROUND

 In sight of increasing bacterial resistances, appropriate and cautious antibiotic therapy (antibiotic stewardship) is becoming more and more important, in private practices as well. A current S3 guideline is available for the treatment of uncomplicated urinary tract infections, which recommends that regular epidemiological examinations of pathogen sensitivity are to be carried out promptly and locally. With this said, the antibiotic prescriptions of the resident doctors in Hesse were examined and compared with the sensitivity of the most important pathogens causing urinary tract infections.

MATERIAL AND METHOD

 The prescription data for antibiotics (ATC J01) for the area of ​​the Association of Statutory Health Insurance Physicians in Hessen for the years 2013 to 2020 were received from Insight Health GmbH & Co. KG, Waldems-Esch, which manages the data. A large laboratory that supplies numerous resident doctors in the Rhine-Main region provided sensitivity data tested according to CLSI until the year 2016 and from 2017 to EUCAST from microbiological examinations of urine samples for the clarification of community-acquired urinary tract infections from the years 2011-2020.

RESULTS

 From 2013 to 2020 the antibiotic prescriptions decreased from 2 692 370 to 1 708 134 (minus 37 %). The prescriptions for cephalosporins were reduced by more than 40 %, those of quinolones by 76 %. Among the antibiotics recommended for urinary tract infections, the most common antibiotics used were fosfomycin (2020: 130 476), followed by co-trimoxazole (2020: 96 559), nitrofurantoin (2020: 37 415), trimethoprim (2020: 27 388), pivmecillinam (20 984) and nitroxoline (6818). Urologists, on the other hand, most frequently prescribed nitrofurantoin (2020: 9951) and co-trimoxazole (9772), followed by fosfomycin (7193), trimethoprim (5050), nitroxoline (3289) and pivmecillinam (2722). Despite the high use of fosfomycin in outpatient medicine, E. coli and Citrobacter spp. exhibited no loss of sensitivity, Proteus mirabilis and S. aureus showed a slight loss of activity, while in Enterobacter cloacae a clear loss of activity was seen. The E. coli strains detected from urine samples to clarify complicated urinary tract infections show continuously excellent sensitivity for fosfomycin, nitrofurantoin, nitroxoline and mecillinam (> > 90 %), whereas the sensitivity against trimethoprim was just under 80 %.

DISCUSSION AND CONCLUSION

 The decrease in antibiotic prescription data from statutory health insurance physicians in Hesse shows that the importance of cautious antibiotic therapy is also gaining ground in outpatient practice. Co-trimoxazole, which continues to be used very frequently, should be avoided in favor of monotherapy with trimethoprim because of the increased side effects of the sulfonamide component with the same effectiveness of trimethoprim. The E. coli strains detected from urine samples to clarify complicated urinary tract infections showed a sensitivity, of just under 80 % to trimethoprim. Since an approximately 10 % better sensitivity rate was found for uncomplicated community-acquired urinary tract infections that usually do not require microbiological diagnostics, in our opinion, in transferring this observation in the Rhine-Main area and in Hesse, trimethoprim can also continue to be used empirically for uncomplicated urinary tract infections.