Presentation Authors: Richard Fantus*, Chicago, IL, Cecilia Chang, Brian Helfand, Evanston, IL
Introduction: Current guidelines recommend that the work-up of men with lower urinary tract symptoms (LUTS) include a urinalysis, consideration of a serum PSA test and digital rectal exam (DRE). Based upon the symptomatology of LUTS, first-line treatment options may be observation or medications. However, it is unclear whether medical specialties follow similar practice guidelines. Therefore, we sought to compare the work-up and treatment of patients with LUTS among different physician specialties.
Methods: We examined every adult male patient (ages 18 and up) visits between 2006 and 2013 in the National Ambulatory Medical Care Survey (NAMCS), which is designed to provide nationally representative estimates of ambulatory visits. Diagnoses of LUTS were determined using International Classification of Disease 9 codes: 600.x, 788.2x, 788.3x, 788.4x, 788.6x, 788.9x, and 599.6x. Demographic information, clinical characteristics, diagnostic tests and medications prescribed were compared between urologists and primary care physicians (PCPs) using chi-squared and t-tests.
Results: Among 36,853 visits, 4170 (11.3%) were associated with at least one LUTS diagnosis. The majority of these patients (78.25%) were seen by a urologist compared to a PCP (17.5%) or other providers (4.25%). Men evaluated by a urologist were more likely to undergo a DRE (27.37% vs 10.41%), PSA test (34.88% vs. 21.92%), and urinalysis (57.37% vs. 17.53%) compared to those evaluated by PCPs (all p < 0.0001). Alpha-blockers were the most frequently prescribed medication by both urologists and PCP (67.62% vs. 82.02%). Urologists, however, were significantly more likely to prescribe anticholinergic medications than PCPs (16.50% vs. 5.68%; p < 0.0001).
Conclusions: While the majority of clinical encounters for LUTS are performed by urologists, non-urologist physician encounters account for over 20% of all visits. This discrepancy can lead to variation in patient care. Men evaluated by urologists are more likely to follow guidelines including a urinalysis, PSA testing (if indicated) and DRE. As the medical field becomes increasingly specialized, interdisciplinary education is paramount to ensure that PCPs can partner with urologists to deliver optimal care to men with LUTS.