GPs' perspectives on diagnosing childhood urinary tract infections: a qualitative study

Abstract

Background: Diagnosis and management of childhood urinary tract infection (UTI) is challenging in general practice because of a range of factors.

Aim: To explore GPs' perspectives concerning the barriers to and facilitators for diagnosis and management of childhood UTI.

Design and setting: Qualitative study in general practice in Belgium.

Method: Semi-structured interviews with 23 GPs from January 2021 to June 2021 were carried out. Interviews were video-recorded and audio-recorded, transcribed verbatim, and analysed using a thematic approach.

Results: The barriers to early diagnosis of UTI were the assumption of low UTI prevalence and aspecific presentation of UTI in children, difficulties in urine collection, and diagnostic uncertainty. All GPs indicated that they sampled urine in either children with specific UTI features (for example, dysuria, abdominal pain) or unexplained fever. Facilitators for UTI screening were instructional material for parents, skill training for GPs, additional nursing staff, novel non-invasive convenient collection methods, online decision support informing parents when to bring a urine sample to the consultation, and an accurate, easy-to-use point-of-care test for UTI. Empirical antibiotic treatment was initiated based on dipstick test results, clinical features suggestive of UTI, severity of illness, gut feeling, long duration of fever, time of the day, and parents' ability to judge disease severity.

Conclusion: The assumption of a low UTI prevalence, absence of obvious UTI features, and difficult urine sampling might cause childhood UTIs to go undetected in general practice. Diagnostic uncertainty makes appropriate treatment challenging.

Keywords: Belgium; child; diagnosis; general practice; parents; qualitative research; uncertainty; urinary tract infections; urine specimen collection.