Objective. To describe physicians’ goals when treating uncomplicated urinary tract infections (UTIs) and the relationship between goals and practice patterns. Study design. Analysis of survey results. Population. Primary care physicians. Outcomes measured. Self-reported treatment objectives and practice patterns. Results. Most physicians reported their UTI management was convenient for the patient (81.3%). Fewer stated they minimized patients’ costs (53.4%), made an accurate diagnosis (56.7%), or avoided unnecessary antibiotics (40.9%). Physicians who stressed convenience or minimizing patient expenses were less likely to use many resources (urine culture, microscopic urinalysis, followup visits and tests, and prolonged antibiotic treatment) and more likely to use telephone treatment. Physicians who stressed accurate diagnoses or avoiding unnecessary antibiotics were more likely to use the same resources and less likely to use telephone treatment. Conclusion. UTI management goals vary across physicians and are associated with different clinical approaches. Differences in treatment objectives may help explain variations in practice patterns.
Get full access to this article
View all access options for this article.
References
1.
1. Eisenberg JM. Doctors’ Decisions and the Cost of Medical Care. Ann Arbor (MI): Health Administration Press Perspectives ; 1986.
2.
2. Gaynor M. Issues in the industrial organization of the market for physician services . J Econ Manage Strat. 1994; 3: 211–55 .
3.
3. Folland S, Stano M. Small area variations: a critical review of propositions, methods, and evidence . Med Care Rev. 1990; 47: 419–65 .
4.
4. Wennberg JE, Barnes BA, Zubkoff M. Professional uncertainty and the problem of suppler-induced demand . Soc Sci Med. 1982; 16: 811–24 .
5.
5. Reinhardt UE. The economist’s model of physician behavior . JAMA. 1999; 281: 462–5 .
6.
6. Dranove D, White WD. Agency and organization of health care delivery . Inquiry. 1987; 24: 405–15 .
7.
7. Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations . Lancet. 1993; 342: 1317–22 .
8.
8. Davis DA, Thomson MA, Oxman DA, Haynes RB. Changing physician performance: a review of the effect of continuing medical education strategies . JAMA. 1995; 274: 700–5 .
9.
9. Greco PJ, Eisenberg JM. Changing physicians’ practices . N Engl J Med. 1993; 329: 1271–3 .
10.
10. Wigton RS, Longenecker JC, Bryan TJ, Parenti C, Flach SD, Tape TG. Variation by specialty in the treatment of urinary tract infections in women . J Gen Intern Med. 1999; 14: 491–5 .
11.
11. Miller RG Jr. Simultaneous Statistical Inference. New York: Springer-Verlag ; 1981.
12.
12. Long JS. Regression Models for Categorical and Limited Dependent Variables. Thousand Oaks (CA): Sage ; 1997.
13.
13. Stata Corporation. Stata software. College Station (TX): Stata Corporation ; 2001.
14.
14. Evans R. Supplier-induced demand: some empirical evidence and implications. In: M Perlman, editor. The Economics of Health Care and Medical Care. New York: John Wiley ; 1974.
15.
15. Stamm WE, Wagner KF, Amsel R, Alexander R, Turck M, Counts GW, et al. Causes of the acute urethral syndrome in women . N Engl J Med. 1980; 303: 409–15 .
16.
16. Kunin CM. Urinary tract infections: flow charts (algorithms) for detection and treatment . JAMA. 1975; 233: 458–62 .
17.
17. Komaroff AL. Acute dysuria in adult women. In: RJ Panzer, ER Black, PF Griner, editors. Diagnostic Strategies for Common Medical Problems. Philadelphia: American College of Physicians ; 1991.
18.
18. Saint S, Scholes D, Fihn SD, Farrell RG, Stamm WE. The effectiveness of a clinical practice guideline for the management of presumed uncomplicated urinary tract infection in women . Am J Med. 1999; 106: 636–41 .
19.
19. Barry HC, Hickner J, Ebell MH, Ettenhofer TE. A randomized controlled trial of telephone management of suspected urinary tract infections in women . J Fam Prac. 2001; 50: 589–94 .
20.
20. Barry HC, Ebell MH, Hickner J. Evaluation of suspected urinary tract infection in ambulatory men: a cost-utility analysis of office based strategies . J Fam Prac. 1997; 44: 49–60 .
21.
21. Fenwick E, Briggs A, Hawke C. Management of urinary tract infections in general practice: a cost-effectiveness analysis . Br J Gen Prac. 2000; 50: 635–9 .
22.
22. Carlson KJ, Mulley AG. Management of acute dysuria: a decision-analysis model of alternative strategies . Ann Intern Med. 1985; 102: 244–9 .
23.
23. Patton JP, Nash DB, Abrutyn E. Urinary tract infections: economic considerations . Med Clin North Am. 1991; 75: 495–513 .
24.
24. Berg AO. Variations among family physicians’ management strategies for lower urinary tract infection in women: a report from the Washington Family Physicians Collaborative Research Network . J Am Board Fam Prac. 1991; 4: 327–30 .
25.
25. Gonzalez M. editor. Physician Marketplace Statistics. Chicago: American Medical Association ; 1993.
