[Clinical microbiological service in general practice in the municipality of Copenhagen. Experiences from the clinical microbiological department at the Hvidovre Hospital 1987-1991].
Since 1987, the clinical microbiological department in Hvidovre Hospital has served physicians in primary health care in the municipality of Copenhagen with microbiological diagnoses and instruction. This paper describes the service model and experience gained during the past four years. During the observation period, the annual number of analyses doubled. In 1990, 66,460 analyses were performed for a total of 399 physicians. The number of specimens per physician varied from 1 to 1903 with a median value of 95. Chlamydia specimens (CS) and vaginal discharge specimens (VDS) examined for yeasts, Gardnerella and Trichomonas comprised the two largest categories. In spite of the increasing number of specimens, the overall rate of positive samples remained unchanged. Physicians who sent many CS in 1990 scored a significantly lower positive rate than physicians who sent few, however, no corresponding difference was demonstrable for VDS. Thus, there is scarcely evidence to assume that microbiological specimens are taken on less strict indications than previously. The increasing number of specimens reflects rather a hitherto uncovered need for microbiological diagnosis in primary health care. Specialists scored significantly lower positive rates for CS and VDS than general practitioners, which may indicate that these specimens are often repeated unnecessarily, when a patient is referred to a specialist. With a view to decentralizing selected categories of specimens, including VDS, courses in microscopy were held, in which one fourth of the physicians of the region participated. A questionnaire survey evaluating the course showed that there is a great interest among physicians in primary health care to perform simplified microbiological diagnosis, but there is still a great need for training and education.