Family Practice Advance Access originally published online on June 27, 2008
Family Practice 2008 25(4):272-278; doi:10.1093/fampra/cmn033
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Improving the appropriateness of laboratory submissions for urinalysis from general practice
a Health Protection Agency Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN
b Gloucestershire Primary Care Trust, Bell Lane Surgery, Minchinhampton, Aberdeen
c Gloucestershire Primary Care Trust, The Surgery, Whitminster Lane, Frampton on Severn Gloucestershire GL2 7HU
d Statistics, Modelling and Bioinformatics, Health Protection Agency, Centre for Infections, 61 Colindale Avenue, London NW9 5EQ
e Gloucester Research and Development Support Unit, Great Western Road, Gloucester GL1 3NN
f Consultant Microbiologist, Pathology Laboratory, County Durham and Darlington Acute Hospitals NHS Trust, Darlington Memorial Hospital, Hollyhurst Road, Darlington DL3 6HX
g Clinical Biochemist, Clinical Laboratory, County Durham and Darlington Acute Hospitals NHS Trust, General Hospital, Bishop Auckland, UK
Correspondence to: Cliodna A M McNulty, Health Protection Agency Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK; Email: cliodna.mcnulty{at}hpa.org.uk
Received 21 August 2007; Accepted 22 May 2008.
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Abstract |
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Background. Urine is the most common microbiology laboratory specimen. Submissions increase annually by 5–10%, and many specimens may be unnecessary.
Objectives. To assess the impact of guidance, implemented by interactive workshops and reinforced with modified request forms, on specimen submission.
Methods. This was a prospective randomized controlled study with modified Zelen design. The study population comprised five primary care trusts (PCTs) in Gloucestershire/County Durham/Darlington, containing 82 general practices in six geographical clusters. The six clusters were randomly assigned to urine workshop covering submission in the elderly, adults and children or a control workshop. Within these groups, half the practices were randomized to receive modified laboratory forms emphasizing the workshop messages. Practices were not aware of the study.
Results. Workshops lead to a 12% reduction in urine submissions from 16- to 64-year olds, which persisted for the 15 months but had no effect on bacteriuria rate. Workshops had no significant effect in the elderly or children. Modified forms were not associated with any reduction in submissions but were associated with an 11% reduction in detection of significant bacteriuria in 16- to 64-year olds.
Conclusions. The 12% decrease in urine submissions from 16- to 64-year olds, attained with workshops, may help counter relentlessly rising test submissions. Modified forms are currently not worth pursuing. When educational workshops are used across PCTs to change practice, the change in test submission is smaller than attained in educational initiatives involving volunteers. Workshops may be more effective if they also discuss urine submissions from asymptomatic patients and are directed at high testing practices and care homes.
Keywords. Children, education, elderly, primary care, RCT, urine testing, UTI.
McNulty CAM, Thomas M, Bowen J, Buckley C, Charlett A, Gelb D, Foy C, Sloss J and Smellie S. Improving the appropriateness of laboratory submissions for urinalysis from general practice. Family Practice 2008; 25: 272–278.
1 Present address Health and Safety Laboratory, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK.