PATIENTS WITH URINARY-TRACT INFECTION - PROPOSED MANAGEMENT STRATEGIES OF GENERAL-PRACTITIONERS, MICROBIOLOGISTS AND UROLOGISTS

Background. It is difficult to implement change in general practice. I t is not known how best to conduct effective continuing medical educat ion in general practice. General practitioners' criteria for good clin ical practice vary and it is unknown whether systematic education by h ospital specialists could be expected to reduce variation between gene ral practitioners. Aim. A study was undertaken to describe general pra ctitioners: microbiologists' and urologists' strategies for diagnosis, treatment, and follow up of female patients with symptoms of urinary tract infection, a common reason for consultation in general practice. The findings of the study were to be used as a base upon which to dis cuss the advantages and disadvantages of using hospital specialists as a resource in general practitioners' peer group based continuing medi cal education. Method. Three vignettes together with several proposals for diagnosis, treatment and follow up were presented in a questionna ire to general practitioners, microbiologists and urologists in Denmar k. The case histories concerned three female patients (aged 10, 30 and 60 years) who consulted their general practitioner for advice. The fe male patients were otherwise healthy and well known to the practice. G eneral practitioners' microbiologists' and urologists' recommendations for good clinical practice were compared. Results. A total of 154 gen eral practitioners (77%), 45 microbiologists (51%) and 54 urologists ( 61%) who were eligible for the study responded to the questionnaire. T here was considerable variation in the management strategies proposed by doctors within each specialty and between the specialties. Microbio logists and urologists were more likely to suggest treating the 30-yea r-old woman by giving advice and a prescription by telephone compared with their general practitioner colleagues. Conversely, the microbiolo gists and urologists were more likely to suggest asking the 10- and 60 -year-old patients to attend the clinic for examination compared with the general practitioners. The general practitioners reported asking t he patients to return for follow up more commonly than the hospital sp ecialists. Conclusion. Large variation in suggested strategies for dia gnosis, treatment and follow up was shown both within and between spec ialties. Continuing medical education of general practitioners based o n small peer group discussions using hospital specialists as a group r esource would not necessarily reduce variation in clinical practice be tween general practitioners A need for evidence-based rather than cons ensus-directed guidelines would be needed in order to reduce variation in clinical practice between doctors.