Patient Satisfaction and Clinical Efficacy of an Advanced Practice Provider Stone Prevention Clinic.

Abstract

The benefits of a multidisciplinary stone prevention clinic are well established. However, the outcomes of advanced practice provider integration into this model have not been reported. Our goal was to assess the feasibility of an advanced practice provider managed stone prevention clinic. High risk kidney stone patients were evaluated by an advanced practice provider and registered dietitian. Medical and dietary interventions were formulated based on medical and dietary history, labs and imaging. Post-intake surveys assessed patient satisfaction and educational impact. Survey results, stone risk parameters and acute stone events were retrospectively reviewed. Paired samples t-tests were used to assess changes in 24-hour urine parameters. We followed 77 patients over an average of 4.34 visits (750±464 days). Of the 63 surveys completed 100% found their visit helpful and 98.4% would recommend the clinic. Of the 65 patients with multiple 24-hour urine studies significant reductions were seen in stone supersaturation profiles for uric acid (54.2%, p <0.01) and calcium phosphate (31.8%, p=0.04). Supersaturation profiles for uric acid, calcium phosphate and calcium oxalate decreased with each followup visit. Number of registered dietician appointments was associated with reduced supersaturation of calcium oxalate (-2.29, p=0.04). Number of advanced practice provider appointments was associated with reduced supersaturation of uric acid (-0.34, p=0.02). In all, 15 patients experienced an acute stone event and 8 patients had 1 or more emergency room visit. The implementation of an advanced practice provider managed stone prevention clinic is feasible in the community setting. This is supported by positive feedback, educational impact and reductions in stone risk parameters.