[Improvement in the clinical management of urinary infections in a health centre by means of a quality management cycle. Analysis using lot quality assurance sampling]

Abstract

Aim: To improve clinical effectiveness of the management of urinary tract infections in a primary care centre by means of a Management Quality Cycle.

Design: Pre-post test.

Setting: Urban primary care centre.

Participants and main outcome measures: We selected a clinical practice guideline for management of urinary tract infection by way of consensus among doctors, and using the evaluation document AGREE. The main points of the protocol chosen, and evaluation indicators were: the prescription of treatment with a single dose of 3 grams of fosfomycin orally without performing a urine strip or urine culture to those patients who met the protocol inclusion criteria. The results of these baseline indicators, as well as evaluation at six months after the intervention started, were reported and discussed with the doctors of medical centre. The measurement was conducted by audit of medical records selected by lot quality assurance sampling (LQAS).

Results: Starting from a level of compliance of the indicators of, at best 52%, at 18 months after the intervention all major indicators had reached an acceptable quality level of 90% (5% alpha and beta 10%).

Conclusions: The introduction of a Management Quality Cycle for management urinary tract infections in our area, appears to modify the behaviour of health professionals and improve the clinical effectiveness.