Related Experiment Video
Updated: Feb 1, 2026
Transurethral Induction of Mouse Urinary Tract Infection
Published on: August 5, 2010
Reducing physician voiding cystourethrogram ordering in children with first febrile urinary tract infection:
Anke Banks1, Susan Samuel1,2, David Johnson1,3
1Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada.
Insights
A multifaceted educational intervention improved physician adherence to guidelines for voiding cystourethrogram (VCUG) use in children with urinary tract infections (UTI). Pediatricians showed greater guideline adherence post-intervention.
Area of Science:
- Pediatric Healthcare
- Clinical Practice Guidelines
- Health Education
Background:
- Physician adherence to clinical practice guidelines remains a challenge.
- Guidelines for voiding cystourethrogram (VCUG) use after first urinary tract infection (UTI) in children are often not followed.
- Effective strategies are needed to improve guideline implementation.
Purpose of the Study:
- To evaluate the impact of a sequenced, multifaceted educational intervention on physician adherence to VCUG use guidelines.
- To assess changes in VCUG ordering rates and adherence proportions.
- To determine if the intervention improved adherence for pediatricians versus non-pediatricians.
Main Methods:
- A pretest-posttest design was used at a single center.
- Three educational interventions (lecture, pathway, fax reminder) were sequenced using the PRECEDE model.
- VCUG ordering proportions and rates were compared before and after the interventions.
Main Results:
- Physician adherence to VCUG guidelines increased significantly post-intervention for both pediatricians and non-pediatricians.
- Pediatricians demonstrated a higher likelihood of guideline adherence compared to non-pediatricians.
- Pediatricians also reduced their overall monthly VCUG ordering rate.
Conclusions:
- Sequenced educational interventions, guided by the PRECEDE model, effectively enhanced physician adherence to clinical guidelines.
- This approach shows promise for improving evidence-based practice in pediatric UTI management.
- Targeted educational strategies can positively influence physician behavior and patient care.
Background:
Physicians often fail to implement clinical practice guidelines. Our aim was to evaluate whether a purposefully sequenced, multifaceted educational intervention would increase physician adherence to a guideline for voiding cystourethrogram (VCUG) use following first urinary tract infection (UTI) in young children.
Methods:
Using a single centre, pretest-posttest design, we compared the proportion of guideline adherent VCUG orders and the VCUG ordering rate before and after three educational interventions (interactive lecture, clinical pathway, faxed reminder) selected and sequenced according to the PRECEDE (Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation) health promotion model.
Results:
One hundred and nine physicians ordered 219 VCUGs for 219 children. Following the interventions, there was an increase in the monthly proportion of adherent VCUGs ordered by pediatricians (analysis of variance (ANOVA) F(2,29) = 3.38, p = .048) and non-pediatricians (ANOVA F(2,28) = 14.71, p < .001). Also, pediatricians decreased their monthly VCUG ordering rate (linear trend incidence rate ratio 0.74, 95% confidence interval (CI) [0.54, 0.99]). Pediatricians were more likely to adhere with the guideline than were non-pediatricians (odds ratio 2.91, 95% CI [1.5, 5.5]).
Conclusion:
Exposure to purposefully sequenced educational interventions based on the PRECEDE model was associated with increased adherence to guideline recommendations.
Related Concept Videos
01:26Urinary Tract Infection I: Introduction
01:25Urinary Tract Infection II: Pathophysiology
01:17Urinary Tract Infection IV: Nursing Management
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:28Urinary Tract Calculi I: Introduction
01:28Urinary Tract Calculi V: Nursing Management