Pediatricians’ Knowledge, Practice Patterns, and Barriers in Treating Lower Urinary Tract Symptoms: A Qualitative Study

Importance: Pediatric lower urinary tract symptoms (LUTS) are common experiences among school-aged children, with prevalence rates reaching as high as 20%. Pediatricians are first-line stakeholders in providing treatment for these bothersome symptoms, yet little knowledge exists about the treatment of LUTS by primary care providers. Evaluating pediatricians’ knowledge, beliefs, and practice patterns toward LUTS is an important step in developing resources to help clinicians treat LUTS and facilitate LUTS treatment at the primary care setting instead of the subspecialty care setting.

Objective: To explore pediatricians’ perspectives on the barriers and facilitators to providing care for children with LUTS and to identify their practices, knowledge, and beliefs about LUTS.

Design: This qualitative study was conducted using semi-structured key informant focus groups of pediatricians from Northern and Central California. A moderator guide was developed based on the social-ecological model, previous literature, and feedback from pediatricians and urology providers. Thematic analysis was performed using deductive and inductive approaches.

Participants: English-speaking pediatricians from Northern and Central California caring for children with or without LUTS.

Results: 15 pediatricians were interviewed. Participants were between the ages of 30-69 years and two were men. Practice types included general outpatient settings, hospital-based/inpatient, and subspecialty. Pediatricians believe pediatric LUTS is a common problem that can significantly impact a child’s well-being. In practice, pediatricians do not actively screen for LUTS beyond the potty training period due to limited clinic visit time and competing healthcare demands. Pediatricians feel limited in their ability to influence behavioral change in the home setting. Referrals to subspecialists are driven by parental mistrust and expectations. School-level factors are identified as barriers to bladder health. Pediatricians wish they had clear guidelines and additional residency education. They also recommend the development of resources for parents and teachers.

Conclusion and Relevance: This information may help develop and implement education tools for the primary care setting, which can be used prior to the onset of LUTS, shifting the focus from treatment to prevention.