Shared care and the management of lower urinary tract symptoms.

Contains fulltext : 57780.pdf (publisher's version ) (Closed access)OBJECTIVE: To investigate associations between the level of shared care and the clinical management of patients with uncomplicated lower urinary tract symptoms (LUTS). SUBJECTS AND METHODS: A cross-sectional survey study was conducted comprising all urologists and a random selection of general practitioners (GPs) in the Netherlands. Questionnaire responses were obtained from 182 urologists (70%) and 261 GPs (55%). The first part of the questionnaire established the physicians' characteristics and the second the level of familiarity with the national shared-care guidelines, arrangements between urologists and GPs, and the availability of a shared-care prostate clinic. The third part presented a written case of a 50-year-old man with clinical uncomplicated LUTS, and asked questions about diagnostic and therapeutic care. RESULTS: The clinical management of LUTS by GPs and urologists differed, particularly for diagnostic procedures. Only a minority of GPs (8%) and urologists (18%) had a shared-care clinic at their disposal. Such clinics were associated with an increase in tests ordered by the GP, e.g. creatinine levels (odds ratio, OR 3.83) and PSA levels (OR 5.93), and a decrease in choosing a watchful-waiting strategy for patients with mild symptoms (OR 0.24). Furthermore, urologists more often chose surgical intervention for moderate symptoms (OR 9.80). CONCLUSION: A shared-care clinic may lead to a shift in primary care towards the working style of urologists. This healthcare may not be as cost-effective as expected by policy makers. Prospective studies are needed to provide better insight in the health outcomes and efficiency of shared-care clinics

Diagnosis and Treatment of Benign Prostatic Hyperplasia Practice Patterns of Primary Care Physicians

To define primary care physicians’ (PCPs) practices in managing patients with benign prostatic hyperplasia (BPH), and to compare these practices to portions of the Agency for Health Care Policy and Research BPH guideline and urologists’ practices. DESIGN: Mail survey. P ARTICIPANTS: Nationwide random sample of PCPs and urologists, selected from the American Medical Association Registry. METHODS: Initial mailing, postcard reminder, second mailing, telephone reminder, final mailing. MAIN RESULTS: Primary care physicians ( n = 444, response = 51%) reported seeing a median of 35 patients with BPH over the preceding year, in contrast to 240 for urologists ( n = 394, response = 68%). Regarding tests recommended by the guideline, two thirds of PCPs reported rarely or never using the American Urological Association (AUA) symptom index, nearly all reported routinely performing digital rectal examinations, and many (66%) reported routinely ordering tests to determine the serum creatinine level. Although considered “optional” by the guideline, more than 90% of PCPs reported routinely ordering a prostate-specific antigen test, while infrequently using other optional tests. Regarding “not recommended” studies, a substantial minority reported selectively or routinely ordering intravenous pyelography (34%) and renal ultrasound (33%), while two thirds reported rarely or never ordering these tests. Eighty-six percent of PCPs reported prescribing medications for BPH over the preceding year; α blockers to a median of 12 patients, and finasteride to a median of 2. Variation in urology referral thresholds was suggested in responses to two patient scenarios. CONCLUSIONS: Primary care physicians are actively managing patients with BPH. Some of their diagnostic evaluations vary from the recommendations of a national guideline and urologists’ practices. Referral thresholds appear to vary considerably. KEY WORDS: prostatic hyperplasia; primary care physicians; practice patterns; practice guideline.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72635/1/j.1525-1497.1997.012004224.x.pd

Perceptions of Prostate Cancer Fatalism and Screening Behavior Between United States-Born and Caribbean-Born Black Males

Cancer fatalism is believed to be a major barrier for cancer screening in Black males. Therefore, the purpose of this study was to compare perceptions of prostate cancer (CaP) fatalism and predictors of CaP screening with Prostate Specific Antigen (PSA) testing between U.S.-born and Caribbean-born Black males. The Powe Fatalism Inventory and the Personal Integrative Model of CaP Disparity Survey were used to collect the following data from males in South Florida. Multivariate logistic regression models were constructed to examine the statistically significant predictors of CaP screening. A total of 211 U.S.-born and Caribbean-born Black males between ages 39–75 were recruited. Nativity was not a significant predictor of CaP screening with PSA testing within the last year (Odds ratio [OR] = 0.80, 95 % confidence interval [CI] = 0.26, 2.48, p = 0.70). Overall, higher levels of CaP fatalism were not a significant predictor of CaP screening with PSA testing within the last year (OR = 1.37, 95 % CI = 0.48, 3.91, p = 0.56). The study results suggest that nativity did not influence CaP screening with PSA testing. However, further studies are needed to evaluate the association between CaP screening behavior and levels of CaP fatalism

The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA

Guidelines conflict regarding recommendations for prostate-specific antigen (PSA) screening for early detection of prostate cancer. The United States Preventive Services Task Force (USPSTF) assigned a grade of D (recommending against screening) for men 75 and older in 2008 and for men of all ages in 2012. We reviewed temporal trends in rates of screening before and after the 2012 recommendation based on a literature search for studies published between 2011/01/01–2016/10/03 on PSA utilization patterns, changes in prostate cancer incidence and biopsy patterns, and how the recommendation has shaped physician and patient attitudes about PSA screening and subsequent ordering of other screening tests. Rates of PSA screening decreased by 3–10 percentage points among all age groups and within most U.S. geographic regions. Rates of prostate biopsy and prostate cancer incidence have declined in unison, with a notable shift towards higher grade, stage and risk upon detection. Despite the recommendation, some physicians reported ongoing willingness to screen appropriately selected men, and men largely reported intending to continue to ask for the PSA test. In the coming years, we expect to have a better picture of whether these decreased rates of screening will impact prostate cancer metastasis and mortality