Yves-Marie Vincent1, Adèle Frachon2, Clotilde Buffeteau2, Guillaume Conort2. 1. Département de Médecine Générale, Université de Bordeaux, Collège Sciences de la santé, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France. vincent.yvesmarie@u-bordeaux.fr. 2. Département de Médecine Générale, Université de Bordeaux, Collège Sciences de la santé, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France.
Abstract
BACKGROUND: Uncomplicated urinary tract infection (uUTI) is very common among women in primary care. The risk of developing pyelonephritis remains low after uUTI, nonetheless, empiric antibiotic therapy is frequently prescribed for symptomatic purposes. This may lead to adverse effects and antibiotic resistance. Furthermore, patients may express the will to limit the use of antibiotics. Some European countries recommend discussing a delayed prescription with the patient and developing a shared decision. The aim of this study is to create a patient decision aid (PtDA) used in primary care settings to make a shared decision between practitioners and women about whether or not to treat uUTI with antibiotics. METHODS: We followed the steps recommended by the International Patient Decision Aids Standards, with a scoping phase, a design phase (including focus groups and literature review), and an alpha-testing phase. A steering group, made of patients and physicians, met throughout the study to develop a prototype PtDA. RESULTS: The information included in the PtDA is the definition of uUTI, information on the options, their benefits, risks, and consequences, based on a review of the literature. The results of the focus group made possible to determine the patient's values and preferences to consider in decision-making, including: the discomfort felt, the impact on daily life, patients' perceptions of antibiotics, and the position relative to the risk of adverse effect. The choices in presentation, organisation and design are the result of the work of the steering group, improved by feedback from alpha testing. We confirmed the need for shared decision-making and the equipoise in this situation. CONCLUSIONS: We developed a PtDA to be used in primary care for sharing decision on the use of antibiotic in uUTI. It needs to be validated in a beta-testing phase, with complementary advice from peers, and then tested in a clinical study comparing its use with the systematic prescription approach.
BACKGROUND: Uncomplicated urinary tract infection (uUTI) is very common among women in primary care. The risk of developing pyelonephritis remains low after uUTI, nonetheless, empiric antibiotic therapy is frequently prescribed for symptomatic purposes. This may lead to adverse effects and antibiotic resistance. Furthermore, patients may express the will to limit the use of antibiotics. Some European countries recommend discussing a delayed prescription with the patient and developing a shared decision. The aim of this study is to create a patient decision aid (PtDA) used in primary care settings to make a shared decision between practitioners and women about whether or not to treat uUTI with antibiotics. METHODS: We followed the steps recommended by the International Patient Decision Aids Standards, with a scoping phase, a design phase (including focus groups and literature review), and an alpha-testing phase. A steering group, made of patients and physicians, met throughout the study to develop a prototype PtDA. RESULTS: The information included in the PtDA is the definition of uUTI, information on the options, their benefits, risks, and consequences, based on a review of the literature. The results of the focus group made possible to determine the patient's values and preferences to consider in decision-making, including: the discomfort felt, the impact on daily life, patients' perceptions of antibiotics, and the position relative to the risk of adverse effect. The choices in presentation, organisation and design are the result of the work of the steering group, improved by feedback from alpha testing. We confirmed the need for shared decision-making and the equipoise in this situation. CONCLUSIONS: We developed a PtDA to be used in primary care for sharing decision on the use of antibiotic in uUTI. It needs to be validated in a beta-testing phase, with complementary advice from peers, and then tested in a clinical study comparing its use with the systematic prescription approach.
Authors: Dawn Stacey; France Légaré; Krystina Lewis; Michael J Barry; Carol L Bennett; Karen B Eden; Margaret Holmes-Rovner; Hilary Llewellyn-Thomas; Anne Lyddiatt; Richard Thomson; Lyndal Trevena Journal: Cochrane Database Syst Rev Date: 2017-04-12
Authors: Florian M Wagenlehner; Dimitri Abramov-Sommariva; Martina Höller; Hubert Steindl; Kurt G Naber Journal: Urol Int Date: 2018-09-19 Impact factor: 2.089
Authors: Andreas Kronenberg; Lukas Bütikofer; Ayodele Odutayo; Kathrin Mühlemann; Bruno R da Costa; Markus Battaglia; Damian N Meli; Peter Frey; Andreas Limacher; Stephan Reichenbach; Peter Jüni Journal: BMJ Date: 2017-11-07
Authors: Vanesa Ramos-García; Lilisbeth Perestelo-Pérez; Amado Rivero-Santana; Wenceslao Peñate-Castro; Andrea Duarte-Díaz; Yolanda Álvarez-Pérez; María Del Mar Trujillo-Martín; María Isabel Del Cura-González; Pedro Serrano-Aguilar Journal: BMC Med Inform Decis Mak Date: 2022-06-30 Impact factor: 3.298