Preventing and managing urinary tract infections: Exploring interventions and strategies implemented by NHS commissioning organisations in English primary care, 2017–2022

The majority of antibiotics are prescribed in primary care. Urinary tract infections (UTIs) are the second most common reason for antibiotic prescribing in this sector. This study explores activities used by English Clinical Commissioning Groups (CCGs) to improve UTI prevention and management 2017-2022. An online questionnaire was sent to CCG primary care chief nurses and medicines optimisation leads August-September 2022. Qualitative data was mapped to the Theoretical Domains Framework. Participant response rate was 14.1% (56/397), with representation from 29.2% (31/106) CCGs and across a range of roles. Education and training were the most reported intervention types, while changing the environment to facilitate behaviours was the least. Most interventions targeted general practice staff and patients, followed by care home staff, and residents and their families.The most reported success measures included reduction in antibiotic prescribing (54.5%, 97/178 interventions); positive stakeholder feedback (42.1%, 75/178); and increased adherence to diagnostic guidelines (32.6%, 58/178). 48.8% (20/41) stated their UTI activities had not been formally evaluated. Barriers and facilitators to intervention implementation included: availability of resources and time; staff collaboration; availability and accuracy of information; public and staff beliefs; systems and processes; and staff roles and responsibilities. UTI interventions rolled out through English health authorities could be further improved through structures that increase capacity to effectively evaluate activities and share learning. Staff engagement and collaboration are key facilitators to implementation and should be leveraged in further initiatives, while support and guidance are provided to adapt initiatives to fit in the changing healthcare landscape.