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Master Thesis

Influence d'un commentaire post analytique dans l'interprétation des analyses d'urines, sur la conformité de la prescription documentée d'antibiotiques : une étude de supériorité cas-vignettes randomisée en double aveugle chez les médecins généralistes en France

Abstract : Objectives: The aim of this study is to assess the influence of a post-hoc comment for interpretation of urinalysis, on the appropriateness of documented antibiotic prescription to the national guidelines in urinary tract infections in general practice in France. Methods: This is a superiority, double-blind randomized case-vignette study among French general practitioners hold between 11-24-2020 and 02-02-2021. The self-questionnaire was broadcasted via any Departmental Medical Order Boards (DMOB), regional residents’ unions, and regional seniors’ unions across France. The primary outcome was the overall appropriateness of the documented antibiotic prescribed by the general practitioner according to last 2020 French guidelines for each case-vignette of urinary tract infections. Results: In total, 640 self-questionnaires were analyzed. The population of respondents was mainly feminine (64.4%), young (mean age 36.4 years old) and users of Clinical Decision Support System (CDSS) (90%). The addition of a post-analytical comment in a urinalysis did not significantly improved the appropriateness of documented antimicrobial therapy (79.1% in the control arm vs 82.1% in the test arm; p=0.384). There was no significant effect on the prescription of broad-spectrum molecules (44.8% in the control arm vs 42% in the test arm; p=0.52). In multivariate analysis, only the type of UTI in the vignettes was influencing the appropriateness of the prescription (p<0.001). Indeed, asymptomatic bacteriuria in pregnancy (OR 36.5, IC95% [7.45-660], p<0.001), uncomplicated pyelonephritis (OR 5.81, IC95% [2.50-15.3], p<0.001) and male urinary tract infection (OR 7.82, IC95% [3.38-20.5], p<0.001) were associated with increased appropriateness. Conclusion: A post-hoc comment in urinalysis performed for UTIs is not improving the overall appropriateness of documented antimicrobial prescribing to national guidelines, in a mainly young population of French general practitioners, using CDSS for antimicrobial prescribing. Further large-scale investigations, including older general practitioners and less users of CDSS should allow to determine the real impact of a post-hoc comment.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03198813
Contributor : Jean-Hugues Morneau <>
Submitted on : Thursday, April 15, 2021 - 10:33:49 AM
Last modification on : Sunday, April 18, 2021 - 3:15:21 AM

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Johann Hurtaud-Marzani, Youssoupha N'Diaye. Influence d'un commentaire post analytique dans l'interprétation des analyses d'urines, sur la conformité de la prescription documentée d'antibiotiques : une étude de supériorité cas-vignettes randomisée en double aveugle chez les médecins généralistes en France. Médecine humaine et pathologie. 2021. ⟨dumas-03198813⟩

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