Tracking unnecessary negative urinalyses to reduce healthcare costs: a transversal study
- 197 Downloads
About 7 million urinalyses are reimbursed yearly by the French public healthcare system, but the results of most of these tests are normal. The aim of this study was to estimate the prevalence of negative urinalyses in ambulatory care, identify the associated factors and assess the relevance of prescriptions by general practitioners (GPs) according to French guidelines. A cross-sectional study was conducted in patients over 18 coming for urinalyses in two French ambulatory laboratories. Patients received a questionnaire on their symptoms, the reason for performing urinalysis and the use of urinary dipsticks. GP who prescribed urinalyses received a questionnaire assessing their practice. A total of 510 patients were included, and 71% of urinalyses were negative. Urinalyses were prescribed to 283 patients by GPs. Compared to those of specialists, GP prescriptions were associated with fewer negative urinalyses (59 vs 86%; p < 0.01). Among the negative urinalyses prescribed by GPs, the reasons of prescription were as follows: suspected urinary tract infection (UTI) (42.7%), control of bacteriological cure after UTI (24%), fever or abdominal pain (13%) and routine test (7%). About 35% of urinalyses were not indicated according to guidelines. Only 12% of patients used dipsticks before performing urinalysis although 87% of GPs were favourable to their use if they were provided by healthcare services. The annual cost of non-indicated urinalyses is estimated at 13 million euro. A systematic use of dipsticks provided by healthcare services could help to reduce health costs and the unnecessary use of antibiotics.
KeywordsUrinary Tract Infection Healthcare Service Urinary Symptom Urinary Dipstick Bacteriological Cure
We thank Dr. Duffier for the coordination of the study in the laboratories and Stéphanie Sidorkiewicz for her advices.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The protocol was approved by an ethics committee (CPP Ile de France II).
Patients received an information letter and had to sign a consent form before their inclusion.
- 1.Commission des comptes de la sécurité sociale (2008) Commission des comptes de la sécurité sociale. Tableau de bord de suivie de la biologie. Données SniiramGoogle Scholar
- 2.Lidsky V, Thiard P-E, Le Brignonen M et al (2012) Propositions pour la maîtrise de l’ONDAM 2013–2017Google Scholar
- 3.Maugat S, Georges S, Nicolau J. (2011) Mise en oeuvre d’un recueil automatisé des données de bactériologie dans des laboratoires d’analyses de biologie médicale privés, 2005–2009. Bilan d’une expérimentation. Inst Veille Sanit:77pGoogle Scholar
- 6.Société de Pathologie Infectieuse de Langue Française (2014) Diagnostic et antibiothérapie des infections urinaires bactériennes communautaires de l’adulteGoogle Scholar
- 7.Pickard, B, Bjerklund J et al. (2016) Guidelines on urological infections 2015—European Association of Urology. https://uroweb.org/guideline/urological-infections/
- 8.Rossignol L, Maugat S, Blake A et al. (2014) Etude Druti: Epidémiologie et prise en charge des infections urinaires en médecine générale en France métropolitaineGoogle Scholar
- 9.Haab F, Costa P, Colau J-C et al. (2008) Les infections urinaires de la femme en médecine générale. Datarevues0755498200359-C11235 Published Online First. http://www.em-consulte.com/en/article/103145 (accessed 11 May 2016).
- 10.Goudot C. (2008) Utilisation des bandelettes urinaires en médecine générale: enquête de pratique auprès des 229 médecins auboisGoogle Scholar
- 11.Distrimed. http://www.distrimed.com (accessed 12 May 2016)
- 12.ProMedis - BHV Médical. http://www.promedis.com/ (accessed 12 May 2016)
- 13.Tests urinaires robe materiel medical. http://www.robe-materiel-medical.com/ (accessed 12 May 2016)
- 14.NovusASC [Internet] (2016) available at: http://novusacs.com/lab-price-list/
- 15.SIGN (2012) Management of suspected bacterial urinary tract infection in adults. http://www.sign.ac.uk/pdf/sign88.pdf (accessed 6 Dec 2016)
- 16.Bent S, Nallamothu BK, Simel DL et al (2002) Does this woman have an acute uncomplicated urinary tract infection? JAMA 287:2701–2710Google Scholar
- 17.Hay AD (2010) Managing UTI in primary care: should we be sending midstream urine samples? Br J Gen Pract 60:479–480. doi: 10.3399/bjgp10X514701