PD47-09 FOLLOW-UP CARE AFTER ED VISITS FOR KIDNEY STONES—A MISSED OPPORTUNITY

Abstract

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II1 Apr 2016PD47-09 FOLLOW-UP CARE AFTER ED VISITS FOR KIDNEY STONES—A MISSED OPPORTUNITY Amy Luckenbaugh, MD Phyllis Yan, MA J. Stuart Wolf, MD Khurshid Ghani, MBChB, MS Brent Hollenbeck, andMD, MS John HollingsworthMD, MS Amy LuckenbaughAmy Luckenbaugh More articles by this author , Phyllis YanPhyllis Yan More articles by this author , J. Stuart WolfJ. Stuart Wolf More articles by this author , Khurshid GhaniKhurshid Ghani More articles by this author , Brent HollenbeckBrent Hollenbeck More articles by this author , and John HollingsworthJohn Hollingsworth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2697AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The emergency department (ED) serves as the entry point for many patients with kidney stones into the healthcare system. When patients with acute renal colic are discharged from the ED, they are typically given instructions for urologic or primary care follow-up. However, data suggest that many do not comply with these recommendations. In doing so, patients may miss an opportunity for secondary stone prevention. To test this hypothesis, we examined patterns of post-ED follow-up care among adults with kidney stones. METHODS We used MarketScan's Commercial Claims and Encounters Database (2003-2006) to identify adults age 18 to 64 years with an ED visit for kidney stones. Next, we determined which patients received post-ED follow-up care, defined as a physician office visit or surgery for kidney stones within 90 days of the index ED claim. We then compared patients who received post-ED follow-up care and those who did not over a variety of sociodemographic characteristics. Finally, we fit multivariable logistic regression models to evaluate the association between receipt of post-ED follow-up care and subsequent secondary stone prevention (i.e., 24-hour urine testing and/or prescription of a preventive pharmacological therapy agent). RESULTS We identified 70,294 patients with an ED visit for kidney stones, of which 53% had follow-up care within 90 days. Among those with post-ED follow-up care, 66% were seen by a urologist. Compared to patients who received follow-up care, those who did not were more likely to be young (P<0.001), have non-salaried employment (P<0.001), and live in a rural area (P<0.001). After controlling for these differences we found that, relative to patients who did not receive follow-up care, those who did were significantly more likely to undergo 24-hour urine testing and be prescribed a preventive pharmacological therapy agent (Figure). Overall, post-ED follow-up care was associated with 36% higher odds of receiving secondary prevention (OR, 1.36; 95% CI, 1.30 to 1.43). CONCLUSIONS A substantial proportion of patients seen acutely in the ED for kidney stones do not have follow-up care for the kidney stone. Given that post-ED follow-up is associated with greater use of secondary prevention, efforts to enhance linkages across settings are needed in order to provide patients with kidney stones more comprehensive care. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1173 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Amy Luckenbaugh More articles by this author Phyllis Yan More articles by this author J. Stuart Wolf More articles by this author Khurshid Ghani More articles by this author Brent Hollenbeck More articles by this author John Hollingsworth More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...