(Poster 59) UTI Management in Older Women: Insights for Improved Care

Objectives: Primary care providers (PCPs) are pivotal in addressing the challenges of recurrent urinary tract infections (rUTIs) in postmenopausal women. We conducted a qualitative investigation with older women to learn about their UTI experiences. Our objective was to gather insights to ultimately improve our ability to identify older women suffering with rUTI and provide them with efficient, patient-centric, evidence-based care.

Methods: We recruited female participants, aged ≥65 years old, to participate in semi-structured interviews regarding their experiences with UTI management and to discuss receptivity to alternate models of care including electronic consultations or remote management of symptoms. Participants were recruited either from an academic Urogynecology practice or through a community based research registry if they reported previous treatment for recurrent UTI. All interviews were completed in a 6-month timeframe from 2024-2025. Interviews were conducted by one team member trained in qualitative interviews (MB). Two team members read de-identified transcripts, developed a thematic codebook following Conventional Content Analysis guidelines, and coded the data using Dedoose software. We then explored the patterns and relationships between codes to identify categories and themes.

Results: Twenty-one women participated in the study (average age of 75 years old). All participants identified as White, and 7 (33.3%) resided in rural areas. Of the total participants, 10 (47.6%) were recruited from the Urogynecology practice, while 11 (52.3%) came from the community registry and therefore were primarily managed by their PCP. Among those in the community registry, 1 (9.1%) had previously seen a Urogynecologist, and 3 (27.3%) had consulted a Urologist. Vaginal estrogen use was more common among those referred to Urogynecology (n=9, 90.0%) compared to only 2 (18.2%) who were managed by a PCP. Five overarching themes emerged from our qualitative codes: 1) Frustration with the burden of UTI symptoms, 2) Positive interactions with PCPs for UTI symptoms, 3) Variability in referral experiences and barriers to specialist care 4) Strong interest in alternative care models, and 5) Confusion of symptom overlap between UTIs and other bladder conditions. Representative Quotes are presented in Table 1.

Conclusions: A qualitative study of older women experiencing UTIs highlighted frustration with the burden of symptoms. Although most participants reported efficient ability to get antibiotics from their PCP, they did not often discuss preventative care for UTIs in this setting. Participants cited lack of referral from PCP, travel and cost as significant barriers to subspecialist care and alternative care models were well received ideas, even among those over 70 years old, for their potential to enhance care efficiency. Persistent confusion between UTIs and other bladder conditions underscores the need for stronger collaboration between PCPs and Urogynecology along with improved patient education.