van Horrik Tessa Mzxk, Colliers Annelies, Blanker Marco H, de Bont Eefje Gpm, van Driel Antoinette A, Laan Bart J, Geerlings Suzanne E, Venekamp Roderick P, Anthierens Sibyl, Platteel Tamara N
Department of Internal Medicine-Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health, Amsterdam, The Netherlands
Department of Family Medicine & Population Health, University of Antwerp, Antwerp, Belgium.
BJGP Open. 2024 Oct 29;8(3). doi: 10.3399/BJGPO.2023.0179. Print 2024 Oct.
Cystitis is commonly treated with antibiotics, although non-antibiotic options could be considered for healthy non-pregnant women. Shared decision making (SDM) can be used in cystitis management to discuss the various treatment options but is not frequently applied in general practice.
To identify barriers and facilitators for applying SDM in cystitis management in general practice.
DESIGN & SETTING: Qualitative explorative research in general practice with healthcare professionals (HCPs; GPs and GP assistants) and healthy non-pregnant women with a recent history of cystitis (patients).
Individual semi-structured interviews were conducted between May and October 2022. We applied a combination of thematic and framework analysis.
Ten GPs, seven GP assistants, and 15 patients were interviewed. We identified the following three main barriers and one key facilitator: (1) applying SDM is deemed inefficient; (2) HCPs assume that patients expect antibiotic treatment and some HCPs consider non-antibiotic treatment inferior; (3) patients are largely unaware of the various non-antibiotic treatment options for cystitis; and (4) HCPs recognise some benefits of applying SDM in cystitis management, including reduced antibiotic use and improved patient empowerment, and patients appreciate involvement in treatment decisions, but preferences for SDM vary.
SDM is infrequently applied in cystitis treatment in general practice owing to the current focus on efficient cystitis management that omits patient contact, HCPs' perceptions, and patient unawareness. Nevertheless, both HCPs and patients recognise the long-term benefits of applying SDM in cystitis management. Our findings facilitate the development of tailored interventions to increase the application of SDM, which should be co-created with HCPs and patients, and fit into the current efficient cystitis management.
膀胱炎通常用抗生素治疗，不过对于健康的非孕妇女性，可以考虑非抗生素治疗方案。共同决策（SDM）可用于膀胱炎管理，以讨论各种治疗选择，但在全科医疗中并不常用。
确定在全科医疗中应用共同决策进行膀胱炎管理的障碍和促进因素。
对医疗保健专业人员（HCPs；全科医生和全科医生助理）以及近期有膀胱炎病史的健康非孕妇女性（患者）进行全科医疗中的定性探索性研究。
在2022年5月至10月期间进行了个体半结构化访谈。我们采用了主题分析和框架分析相结合的方法。
采访了10名全科医生、7名全科医生助理和15名患者。我们确定了以下三个主要障碍和一个关键促进因素：（1）应用共同决策被认为效率低下；（2）医疗保健专业人员认为患者期望抗生素治疗，一些医疗保健专业人员认为非抗生素治疗较差；（3）患者基本上不知道膀胱炎的各种非抗生素治疗选择；（4）医疗保健专业人员认识到在膀胱炎管理中应用共同决策的一些好处，包括减少抗生素使用和增强患者自主权，患者也赞赏参与治疗决策，但对共同决策的偏好各不相同。
由于目前注重省略患者接触、医疗保健专业人员看法和患者不知情情况的高效膀胱炎管理，共同决策在全科医疗中很少用于膀胱炎治疗。然而，医疗保健专业人员和患者都认识到在膀胱炎管理中应用共同决策的长期好处。我们的研究结果有助于制定量身定制的干预措施，以增加共同决策的应用，这些措施应与医疗保健专业人员和患者共同制定，并适应目前的高效膀胱炎管理。
