Lugtenberg et al. BMC Family Practice 2010, 11:51 http://www.biomedcentral.com/1471-2296/11/51 Open Access RESEARCH ARTICLE © 2010 Lugtenberg et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Com- mons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduc- tion in any medium, provided the original work is properly cited. Research article Guidelines on uncomplicated urinary tract infections are difficult to follow: perceived barriers and suggested interventions Marjolein Lugtenberg* 1,4 , Jako S Burgers 2 , Judith M Zegers-van Schaick 1,3 and Gert P Westert 1,4 Abstract Background: Urinary tract infections (UTI) are among the most common health problems seen in general practice. Evidence-based guidelines on UTI are available, but adherence to these guidelines varies widely among practitioners for reasons not well understood. The aim of this study was to identify the barriers to the implementation of a guideline on UTI perceived by Dutch general practitioners (GPs) and to explore interventions to overcome these barriers. Methods: A focus group study, including 13 GPs working in general practices in the Netherlands, was conducted. Key recommendations on diagnosis and treatment of uncomplicated UTI were selected from the guideline. Barriers to guideline adherence and possible interventions to address these barriers were discussed. The focus group session was audio-taped and transcribed verbatim. Barriers were classified according to an existing framework. Results: Lack of agreement with the recommendations, unavailable and inconvenient materials (i.e. dipslides), and organisational constraints were perceived as barriers for the diagnostic recommendations. Barriers to implementing the treatment recommendations were lack of applicability and organisational constraints related to the availability of drugs in pharmacies. Suggested interventions were to provide small group education to GPs and practice staff members, to improve organisation and coordination of care in out of hour services, to improve the availability of preferred dosages of drugs, and to pilot-test guidelines regionally. Conclusions: Despite sufficient knowledge of the recommendations on UTI, attitudinal and external barriers made it difficult to follow them in practice. The care concerning UTI could be optimized if these barriers are adequately addressed in implementation strategies. The feasibility and success of these strategies could be improved by involving the target group of the guideline in selecting useful interventions to address the barriers to implementation. Background Urinary tract infection (UTI) is one of the most common health problems for which patients seek medical care. It is responsible for about 1% of all general practitioner (GP) consultations in the UK [1] and results in approximately 7.9 million physician visits in the United States annually [2]. In the Netherlands, UTIs rank 8 th on the list of most common reasons for visiting a GP and also account for 1% of all visits [3]. Most of these are uncomplicated UTIs, defined as cystitis in non-pregnant adult women. In the Dutch healthcare system, uncomplicated UTI is diag- nosed and treated by GPs and rarely needs specialist care. To optimize care concerning uncomplicated UTI, evi- dence-based clinical guidelines have been developed in several countries [4]. However, adherence to these guide- lines has shown to be far from optimal. In a large study among a representative sample of general practices in the Netherlands, it was found that GPs followed the guideline with respect to the treatment of UTIs in 42% of the cases and that the level of adherence varied widely (0-95%) between practices [5]. A recent study showed that Dutch GPs treated UTIs according to the guideline in 50% of the cases [6]. In other countries similar levels of adherence regarding the treatment of UTIs were found [7-9]. Rea- sons underlying GPs suboptimal behaviour are thus far poorly understood [6-9]. * Correspondence: m.lugtenberg@uvt.nl 1 Scientific Centre for Transformation in Care and Welfare (Tranzo), Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands Full list of author information is available at the end of the article