Primary Care Clinicians’ Perspectives on Management of Skin and Soft Tissue Infections: An Iowa Research Network Study


  • Funding for this research was from the Agency for Healthcare Quality and Research, HHSA2902007100121.

  • The authors acknowledge the participation of the IRENE family physician offices—Family Medicine Clinic, Le Mars, Iowa; Family Medicine Associates, PC, Guttenberg, Iowa; Genesis Family Medicine, Davenport and Blue Grass, Iowa; Regional Family Health, Manchester, Iowa; The Country Doctor, Bloomfield, Iowa; Urbandale Family Physicians, Urbandale, Iowa; and the University of Iowa Health Care River Crossing, Riverside, Iowa. For further information, contact: Jeanette M. Daly, RN, PhD, 01290-F PFP, 200 Hawkins Drive, Iowa City, IA 52242; e-mail


An estimated 95,000 people developed methicillin-resistant Staphylococcus aureus (MRSA) infections during 2005 of which 14% were community-associated and 85% were hospital or other health setting associated, and 19,000 Americans died from these infections that year.

Purpose: To explore health care providers’ perspectives on management of skin and soft tissue infections to gain a better understanding of the problems faced by busy providers in primary care settings.

Methods: Focus group meetings were held at 9 family physician offices in the Iowa Research Network. Seventy-eight clinicians including physicians, nurses, nurse practitioners, and house officers attended. Meeting audiotapes were transcribed and coded by 3 investigators, and a MRSA-management taxonomy was developed.

Findings: The main themes that emerged from the focus groups included epidemiology, diagnosis, treatment, management, prevention, special populations, and public relations. The incidence of MRSA infections was perceived to have increased over the past decade. However, diagnosis and treatment protocols for physicians in the outpatient setting have lagged behind, and no well-accepted diagnostic or treatment algorithms were used by physicians attending the focus groups.

Conclusion: The clinicians in this study noted considerable confusion and inconsistency in the management of skin and soft tissue infections, particularly those due to MRSA.