Doctor-related Knowledge, Attitudes and Practices (KAP) factors influencing antibiotic prescribing for urinary tract infections in primary care in Singapore: a cross-sectional study.

Abstract

BACKGROUND: The incidence of antimicrobial resistance (AMR) has been on a constant rise for urinary tract infections (UTIs). This study aimed to assess the knowledge, attitudes and practices of primary care doctors on antibiotic prescribing for patients with uncomplicated cystitis, and identify potential areas of intervention to improve appropriate antibiotic prescribing for these patients. MATERIALS AND METHODS: This is a cross-sectional study conducted on 127 primary care physicians (PCPs) recruited from privately funded primary care clinics in Singapore between January and December 2023. The survey was anonymous and self-administered. Factor analysis was performed to derive latent factors which were included in the multivariable logistic regression analysis to assess for independent factors associated with inappropriate antibiotic prescribing. RESULTS: Thirty-five percent of respondents prescribed antibiotics inappropriately for uncomplicated cystitis. Only 57 (45%) were aware of the symptoms indicative of an UTI and only 63 (50%) primary care doctors reported always using urine dipsticks for patients consulting for UTI symptoms. After adjusting for potential confounding factors, primary care doctors who desire to improve their clinical practice (aOR 0.55, 95% CI 0.35-0.87, P=0.010) were less likely to prescribe antibiotics inappropriately for uncomplicated cystitis. In contrast, doctors who have practised in the current clinic for ten years and more (aOR 3.72, 95% CI 1.05-13.22, P=0.042) were more likely to prescribe antibiotics inappropriately for uncomplicated cystitis. CONCLUSIONS: Active promotion of clinical guidance about treatment of UTI targeting experienced primary care doctors can encourage the appropriate prescribing of antibiotics for uncomplicated cystitis. However, more research is needed to assess its effectiveness.