How Physicians Diagnose Urinary Tract Infections
The Potential Influence of Laboratory Regulations on Test Availability and Use
* OBJECTIVE Physician office laboratory regulations may decrease test availability. We examined the potential effects of regulations on test availability and whether the use of tests in diagnosing uncomplicated urinary tract infections is related to availability.
* STUDY DESIGN We performed an analysis of a cross-sectional survey conducted in 1994 and 1995. Test availability and use were determined by physicians' reports.
* POPULATION The survey respondents included practicing physicians in 3 specialties (family medicine, general internal medicine, and obstetrics and gynecology) from 4 states: Pennsylvania (which had longstanding office laboratory regulations), and Alabama, Minnesota, and Nebraska (states that were not regulated until the implementation of the Clinical Laboratory Improvement Amendment of 1988).
* OUTCOMES MEASURED We determined whether 4 specific tests were available in the office and how the tests were used to diagnose uncomplicated urinary tract infections.
* RESULTS Our analysis was based on the responses from the 1898 respondents to the survey. All tests were less commonly available in Pennsylvania; this included the dipstick, microscopic urinalysis, wet prep, and urine culture (odds ratio [OR]=0.20-0.34; all P values [is less than] .05). The availability of the microscopic urinalysis and culture increased their use (OR = 4.37 and 2.03, respectively; P=.001). The availability of microscopic urinalysis was associated with a decrease in ordering urine cultures (OR=0.42; P=.001), and the availability of the dipstick was associated with a decrease in the use of both the microscopic urinalysis (OR=0.36; P=.02) and the culture (OR=0.48; P=.05).
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* CONCLUSIONS We found lower test availability in the state with office laboratory regulations and a decrease in testing when availability is reduced, suggesting that laboratory regulations may influence physicians' diagnostic approach to urinary tract infections. Further study will be required to determine the level of testing that maximizes patient welfare.
* KEY WORDS Laboratory regulations [non-MESH]; diagnostic tests, routine; urinary tract infections; clinical strategies [non-MESH]; test availability [non-MESH]. (J Fam Pract 2001; 50:613)
Submitted, revised, April 22, 2001.
From the University of Iowa College of Medicine, Department of Internal Medicine, Iowa City (S.D.F.); the Section of General Internal Medicine, Department of Internal Medicine University of Nebraska Medical Center College of Medicine, Omaha (S.D.F., R.S.W., T.G.T.); the Department of Medicine, Abington Memorial Hospital, Philadelphia (J.C.L.); the Department of Medicine. University of Minnesota, Minneapolis (C.P.); and the Division of General Medicine. Department of Medicine, University of Alabama at Birmingham (T.J.B.). is now at The University School of Hygiene and Public Health. Baltimore, Maryland.
This research was presented at the 1998 Annual Meeting of the Society for Medical Decision Making. (Flach SD, Wigton RS, Tape TG, Longenecker C, Parenti C, Bryan T. How doctors diagnose urinary tract infection: the potential influence of laboratory regulations on test prevalence and use. Med Decis Making 1998; 18:4. Abstract.)
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