Abstract Background Urinary tract infections (UTIs) are common and result in significant morbidity, negative impacts on daily life, reduced quality of life and reduced work attendance. Recurrence is common and recurrent UTIs have an estimated annual prevalence of 3%. The experience of women with recurrent UTIs is not well understood and how this compares to the views of healthcare professionals (HCPs) is unknown. Objectives This qualitative evidence synthesis aims to understand the experiences of women with recurrent UTIs and compare them to primary care HCPs. Methods We systematically searched MEDLINE, Embase, CINAHL, PsychInfo, ASSIA, Web of Science and the grey literature from inception to June 2022 for primary qualitative studies. Meta-ethnography was conducted to synthesize the studies and the findings for women with recurrent UTIs and HCPs were then compared. Results Twelve primary qualitative studies published from 2005 to 2022 and conducted in Europe and the USA were included. Two studies involved primary care staff; nine studies involved women with experience of recurrent UTIs. One study involved both. Patients and HCPs had similar views in terms of the causes of recurrent UTIs and self-management and similar concerns about an underlying cause and antibiotic use. They also had similar views on the impact of recurrent UTIs, however patients felt HCPs did not appreciate the impact of recurrent UTIs. There were conflicts in terms of the expectation for antibiotics and the need for further investigation and referral. Conclusions This is the first qualitative evidence synthesis on the experiences of women with recurrent UTIs and the views of primary care HCPs. It demonstrates that women with recurrent UTIs and HCPs share several similar views and concerns but there were significant communication gaps. Further guidance development and a patient decision aid could help address these gaps.
Since 2020, England’s Pharmacy Quality Scheme (PQS) has incentivised increased antimicrobial stewardship (AMS) activities in community pharmacy. In 2020/21, this included the requirement for staff to complete an AMS e-Learning module, pledge to be an Antibiotic Guardian and develop an AMS Action plan. To build and embed these initiatives, in 2021/22, the PQS required the use of the TARGET Antibiotic Checklist (an AMS tool for use when patients present with a prescription for antibiotics to support conducting and recording of a series of safety and appropriateness checks against each prescribed antibiotic). This paper describes the implementation of the national PQS criteria from 2020 to 2022, and details community pharmacies’ AMS activities and barriers to implementation of the 2021/22 criteria. A total of 8374 community pharmacies submitted data collected using the TARGET Antibiotic Checklist for 213,105 prescriptions; 44% surpassed the required number for the PQS. Pharmacy teams reported checking the following: duration, dose, and appropriateness of antibiotics; patient allergies and medicine interactions (94–95%); antibiotic prescribing guideline adherence (89%); and the patient’s previous use of antibiotics (81%). The prescriber was contacted for 1.3% of TARGET Antibiotic Checklists (2741), and the most common reasons for such contacts were related to dose, duration, and possible patient allergy. A total of 105 pharmacy staff responded to a follow-up questionnaire, which suggested that some AMS principles had been embedded into daily practice; however, the necessary time commitment was a barrier. The PQS was able to incentivise mass AMS activities at pace over consecutive years for England’s community pharmacies simultaneously. Future research should monitor the continuation of activities and the wider impacts on primary care.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)