Associations Between Provider Specialty and Use of Follow-up Testing Among Patients on Preventive Pharmacological Therapy for Urinary Stone Disease.

Abstract

The AUA Medical Management of Kidney Stones guideline outlines recommendations on follow-up testing for patients prescribed preventive pharmacological therapy. We evaluated adherence to these recommendations by provider specialty. Using claims data from working-age adults with urinary stone disease (2008-2019), we identified patients prescribed a preventive pharmacological therapy agent (a thiazide diuretic, alkali citrate therapy, allopurinol, or a combination thereof) and the specialty of the prescribing physician (urology, nephrology, and general practice). Next, we identified patients who completed a 24-hour urine collection prior to their prescription fill. We then measured adherence to 3 recommendations outlined in the AUA guideline. Finally, we fit multivariable logistic regression models evaluating associations between prescribing provider specialty and adherence to recommended follow-up testing. Among 2,600 patients meeting study criteria, 1,523 (59%) adhered to ≥1 follow-up testing recommendation, with a significant increase over the study period. Nephrologists had higher odds of adherence to ≥1 follow-up test compared to urologists (odds ratio, 1.52; 95% confidence interval, 1.19-1.94; P < .01). Significant differences in adherence to the 3 individual guideline recommendations were also observed by specialty. Following initiation of preventive pharmacological therapy, adherence to guideline-recommended follow-up testing was low overall. There exist meaningful specialty-specific differences in the use of this testing.