PD51-05 THE BURDEN OF KIDNEY STONES IN PRIMARY CARE

Abstract

You have accessJournal of UrologyStone Disease: Evaluation III1 Apr 2015PD51-05 THE BURDEN OF KIDNEY STONES IN PRIMARY CARE Melissa Mendez, Michael Lipkin, Glenn Preminger, and Charles Scales Melissa MendezMelissa Mendez More articles by this author , Michael LipkinMichael Lipkin More articles by this author , Glenn PremingerGlenn Preminger More articles by this author , and Charles ScalesCharles Scales More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1765AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary lithiasis is a highly prevalent condition in the United States, affecting nearly 1 in 11 persons in their lifetime. Many stones pass without requiring surgical intervention, and uneven workforce distribution reduces access to urologic care in many areas. Patients may be initially evaluated or managed by primary care physicians. Given this context, we sought to characterize the utilization of primary care visits for patients with urinary stones in the United States. METHODS We performed a cross-sectional analysis of ambulatory visits for patients with upper tract stones between 2008 and 2010 using the National Ambulatory Care Survey (NAMCS). NAMCS is a multistage probability survey of non-hospital-based outpatient visits in the United States. It is specifically designed to provide nationally representative estimates of healthcare utilization. The survey includes information regarding patient demographics, health conditions, services and physician specialty. Visits were identified using ICD-9-CM diagnostic codes. National estimates were compared using the Rao-Scott chi square test or univariate linear regression, as appropriate. All analyses accounted for the complex sampling structure of the NAMCS. RESULTS During the study period, an estimated 10.6 million ambulatory visits for patients with upper tract stones occurred. Urologists provided care at just more than half of these visits (56%), and primary care physicians provided care during 33% of visits. Patients seen in primary care were younger (46.4 vs. 53.0 years, p = 0.01) and more likely to be of non-white ethnicity (26% vs 11%, p = 0.007) than those seen by a urologist. There were no differences in visits to primary care versus urology by patient sex or metropolitan location. Most visits (61%) to primary care were for a new presentation of a stone, with a smaller proportion for a recurrence of chronic stone disease (16%). In contrast, only about one-third of visit to urologists represented new presentation of a stone (p<0.001 vs primary care). CONCLUSIONS A substantial portion of ambulatory visits for patients with kidney stones occurs in the primary care setting. Many of these visits are for new onset of a symptomatic stone. Further research is required to gain a better understanding of utilization, variation, and outcomes of care for these patients. For patients not requiring surgical intervention, treatment in a primary care setting may provide a lever to reduce the overall cost of care for kidney stones in the United States. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1110 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Melissa Mendez More articles by this author Michael Lipkin More articles by this author Glenn Preminger More articles by this author Charles Scales More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...