title: How physicians diagnose urinary tract infections: the potential influence of laboratory regulations on test availability and use.
abstract: 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.
  
  
  METHODS
  We performed an analysis of a cross-sectional survey conducted in 1994 and 1995. Test availability and use were determined by physicians' reports.
  
  
  METHODS
  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).
  
  
  METHODS
  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 < .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).
  
  
  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&rsquo diagnostic approach to urinary tract infections. Further study will be required to determine the level of testing that maximizes patient welfare.
authors.affiliation: University of Iowa College of Medicine, 200 Hawkins, Iowa City, IA 52242, USA. sdflach@aol.com
authors.forename: S D
authors.initials: SD
authors.lastname: Flach
authors.forename: R S
authors.initials: RS
authors.lastname: Wigton
authors.forename: J C
authors.initials: JC
authors.lastname: Longenecker
authors.forename: C
authors.initials: C
authors.lastname: Parenti
authors.forename: T J
authors.initials: TJ
authors.lastname: Bryan
authors.forename: T G
authors.initials: TG
authors.lastname: Tape
mesh_terms: D000328:Adult; D000407:Alabama; D003430:Cross-Sectional Studies; D003625:Data Collection; D003950:Diagnostic Techniques, Urological / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007753:Laboratories / Q000331:legislation & jurisprudence*; D008910:Minnesota; D009329:Nebraska; D010414:Pennsylvania; D016482:Urinalysis / Q000706:statistics & numerical data*; D014552:Urinary Tract Infections / Q000175:diagnosis*