Title: IMproving Prophylactic Antibiotic use for Recurrent urinary Tract infection (IMPART): mixed-methods study to address evidence gaps and develop a decision aid)
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Research Aim The aim of this research is to improve the use of long-term antibiotics used to prevent urinary tract infections (UTIs) in patients who have recurrent UTIs. This research will present new information about the benefits and harms of long-term antibiotics and develop a decision aid. This will facilitate shared decision-making between patients and clinicians on the different options to manage recurrent UTIs. Background UTIs are very common in women, affecting 10-13% each year. Further infections following treatment are common. Approximately three percent of those affected will develop recurrent UTIs, which are defined as two UTIs in six months or three in 12 months. The main treatment for recurrent UTIs are long-term antibiotics which have been shown to be effective. The concern is the development of antibiotic resistance but the effect of long-term antibiotics on resistance is unknown. There are also a number of non-antibiotic options, but less is known about their effectiveness. It is therefore vital to establish the long-term effects of antibiotics used for this reason and the effectiveness of alternative options. Methods The project will involve four stages towards developing the decision aid. The first stage will involve assessing the current research evidence on long-term antibiotics and nonantibiotic options for recurrent UTIs. The options will be compared against each other to assess their effectiveness. This stage will also assess the available evidence on the concerns and views of patients and clinicians to identify key content for the decision aid. The second stage will use secure and unidentifiable healthcare data from Wales using the Secure Anonymised Information Linkage (SAIL) Databank. Patients with recurrent UTIs will be grouped into those taking long-term antibiotics and those not. The effect on antibiotic resistance will then be assessed from anonymised hospital and urine sample data. The third stage will involve patients and clinicians to establish what both parties feel are the important aspects in making a decision about management in recurrent UTIs. This will inform the decision aid content. The final stage will involve asking patients what they think of the early decision aid design and how it could be improved. The applicant for this fellowship will develop the necessary experience and skills during this project to ensure delivery. They will be supported by supervisors and collaborators with expertise in using unidentifiable patient data, specialised interview techniques and analysis and decision aid development.

Lay abstract: Research Aim The aim of this research is to improve the use of long-term antibiotics used to prevent urinary tract infections (UTIs) in patients who have recurrent UTIs. This research will present new information about the benefits and harms of long-term antibiotics and develop a decision aid. This will facilitate shared decision-making between patients and clinicians on the different options to manage recurrent UTIs. Background UTIs are very common in women, affecting 10-13% each year. Further infections following treatment are common. Approximately three percent of those affected will develop recurrent UTIs, which are defined as two UTIs in six months or three in 12 months. The main treatment for recurrent UTIs are long-term antibiotics which have been shown to be effective. The concern is the development of antibiotic resistance but the effect of long-term antibiotics on resistance is unknown. There are also a number of non-antibiotic options, but less is known about their effectiveness. It is therefore vital to establish the long-term effects of antibiotics used for this reason and the effectiveness of alternative options. Methods The project will involve four stages towards developing the decision aid. The first stage will involve assessing the current research evidence on long-term antibiotics and nonantibiotic options for recurrent UTIs. The options will be compared against each other to assess their effectiveness. This stage will also assess the available evidence on the concerns and views of patients and clinicians to identify key content for the decision aid. The second stage will use secure and unidentifiable healthcare data from Wales using the Secure Anonymised Information Linkage (SAIL) Databank. Patients with recurrent UTIs will be grouped into those taking long-term antibiotics and those not. The effect on antibiotic resistance will then be assessed from anonymised hospital and urine sample data. The third stage will involve patients and clinicians to establish what both parties feel are the important aspects in making a decision about management in recurrent UTIs. This will inform the decision aid content. The final stage will involve asking patients what they think of the early decision aid design and how it could be improved. The applicant for this fellowship will develop the necessary experience and skills during this project to ensure delivery. They will be supported by supervisors and collaborators with expertise in using unidentifiable patient data, specialised interview techniques and analysis and decision aid development.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;6.1 PHARMACEUTICALS
Health categories: RENAL AND UROGENITAL;INFECTION