title: Tracking unnecessary negative urinalyses to reduce healthcare costs: a transversal study.
abstract: 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.
authors.affiliation: Department of Family Medicine, University of Medicine Paris Descartes-Site Cochin, 24, rue du Faubourg Saint-Jacques, 75014, Paris, France. malmartel.alexandre@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Malmartel
authors.affiliation: Department of Family Medicine, University of Medicine Paris Descartes-Site Cochin, 24, rue du Faubourg Saint-Jacques, 75014, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Dutron
authors.affiliation: Department of Family Medicine, University of Medicine Paris Descartes-Site Cochin, 24, rue du Faubourg Saint-Jacques, 75014, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Ghasarossian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005602:France / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D062486:Public Health Surveillance; D012307:Risk Factors; D016482:Urinalysis / Q000379:methods / Q000592:standards; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
keywords: Bacteriological Cure; Healthcare Service; Urinary Dipstick; Urinary Symptom; Urinary Tract Infection