A University of Nebraska Medical Center researcher is seeking 1,000
women with urinary tract infections (UTI) to participate in a study that
will try to determine the best method of diagnosing uncomplicated UTI while
minimizing costs.
The study, which is currently underway, is being directed by Gay Canaris,
M.D., M.S.P.H., assistant professor in the internal medicine department.
Women who suspect they have a UTI can take part in the study by going to
one of the University Medical Associates health centers participating in
the study.
Participants will be asked to provide a urine specimen. Half of the
specimen will be tested at the direction of the patient’s primary care
provider, according to their usual and customary care. The other half of
the specimen will be sent to UNMC’s clinical lab for a dipstick urinalysis,
microscopic urinalysis and urine culture, which is considered the gold
standard for diagnosing UTI.
UTI is among the most common complaints addressed by health care providers
in the ambulatory care setting, accounting for nearly 7 million physician
office visits annually at a cost of approximately $1 billion.
“This is a very common problem among women,” Dr. Canaris said. “It can
be an aggravating condition, but one that is very treatable with antibiotic
medication.”
The study was prompted because there is no standard of care in how complaints
of UTI are handled. “We know that most health care professionals will perform
dipstick urinalysis in their office and often treat on the basis of the
dipstick alone,” Dr. Canaris said.
The problem with doing this is that the dipstick urinalysis is not always
accurate. Thus, many patients receive antibiotics for a UTI, even though
they don’t have a UTI. “The danger of prescribing antibiotics
is that over time the bacteria will develop a resistance to the antibiotic,”
Dr. Canaris said.
“It’s a predicament, however, because we don’t want to miss anyone who
has a UTI either. Women understandably want immediate treatment for the
problem. A woman with UTI symptoms doesn’t want to wait for two days for
the results of a urine culture to come back. The dipstick provides results
instantaneously, but it may be falsely positive or falsely negative.”
Participants in the study will receive no pay, Dr. Canaris said. They
must 19 years or older to enroll. Participation in the study will not change
their care. However, it is possible that a woman not prescribed antibiotics
may be found to have a positive urine culture in the study. That information
will be provided to the participating primary care providers.
“It’s a fine line,” she said. “The ultimate goal with urinary tract
infections is to maximize the number of people we correctly diagnose with
UTI and minimize the number of people who wind up getting treated with
antibiotics even though they don’t have a UTI.”
Dr. Canaris said the study has two specific objectives: to determine
the incremental cost of gains in diagnostic accuracy associated with progressively
more complex testing strategies; and to provide feedback to physicians
regarding the most effective diagnostic strategy for their patients.
Dr. Canaris praised the participating UMA health centers for taking
the time and effort required to enroll people in the study. She said one
health center — the UMA health center at 2380 W. 8th Ave. in Plattsmouth
— has already enrolled 100 patients in the study. The UMA health center
at Brentwood Village, 8021 S. 84th St., is running a close second with
about 70 to 80 women enrolled.
Other participating UMA health centers include the following locations:
Mission Village, 16909 Q St.; Turner Park, 2955 Farnam St.; Summit Plaza,
3604 Summit Plaza Drive; Eagle Run, 13708 Maple St.; Council Bluffs, 1751
Madison Ave.; and the Internal Medicine Clinic at the Durham Outpatient
Center on the main UNMC campus, 44th and Emile streets. For more information
on the study, call 559-7504.
UNMC is the only public academic health science center in the state.
Through its commitment to research, education and patient care, UNMC has
established itself as one of the country’s leading centers for cancer research
and treatment and solid organ transplantation. More than $34 million in
research grants and contracts are awarded to UNMC scientists annually.
In addition, UNMC’s educational programs are responsible for training more
health professionals practicing in Nebraska than any other institution.