title: Improving the appropriateness of laboratory submissions for urinalysis from general practice.
abstract: BACKGROUND
  Urine is the most common microbiology laboratory specimen. Submissions increase annually by 5-10%, and many specimens may be unnecessary.
  
  
  OBJECTIVE
  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.
authors.affiliation: Health Protection Agency Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL13NN, UK. cliodna.mcnulty@hpa.org.uk
authors.forename: Cliodna Am
authors.initials: CA
authors.lastname: McNulty
authors.forename: Michael
authors.initials: M
authors.lastname: Thomas
authors.forename: Joanne
authors.initials: J
authors.lastname: Bowen
authors.forename: Charles
authors.initials: C
authors.lastname: Buckley
authors.forename: Andre
authors.initials: A
authors.lastname: Charlett
authors.forename: David
authors.initials: D
authors.lastname: Gelb
authors.forename: Chris
authors.initials: C
authors.lastname: Foy
authors.forename: John
authors.initials: J
authors.lastname: Sloss
authors.forename: Stuart
authors.initials: S
authors.lastname: Smellie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004496:Education, Continuing / Q000379:methods*; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007753:Laboratories / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D006113:United Kingdom; D016482:Urinalysis / Q000379:methods* / Q000706:statistics & numerical data