Abstract
Whether prevention of Urolithiasis is worthwhile is the outcome of the balance between efficacy of prevention and costs and efforts related of respectively prevention and treatment of a new stone. Well controlled trials demonstrate that effective prevention of new stone formation is possible using medical treatment and lifestyle interventions. In long-term general practice the results obtained with preventive interventions is disappointing. Low and diminishing long-term compliance to the intervention is a major cause for this. Both the long-term aspect and the natural resistance to lifestyle changes contribute to this low compliance. From an analysis of the existing data on trials of preventive interventions and from experiences obtained in other patient groups where lifestyle changes are applied I will make the case that self-empowerment of the patient using m-health lifestyle coaching (a smart phone application) can considerably enhance the level of prevention that is obtained in general practice. In conclusion, I will describe what features will improve usage and efficacy of such an app.
Highlights
The considerable improvements of methods for stone removal that occurred the last decades may raise theStone formation is a big problem in numbers of patients with a prevalence of around 10 % in the USA [1] and an increasing incidence [2, 3]
It has a high recurrence rate, 27–50 % within 5 years after a first urinary stone when no specific treatment is given [4, 5]. Given this extent of the problem, researchers have used cost–benefit models to investigate how the costs for prevention, coaching and medication, compared to costs related to stone recurrence, removal and societal costs such as productivity loss
Comparing the approaches followed in the different centers they concluded that the best compliance was obtained by giving frequent and clear coaching: “the patients find it easier to adhere to a specific dietary regimen than to general instructions.”
Summary
Stone formation is a big problem in numbers of patients with a prevalence of around 10 % in the USA [1] and an increasing incidence [2, 3] It has a high recurrence rate, 27–50 % within 5 years after a first urinary stone when no specific treatment is given [4, 5]. In the UK a single large stone center could save up to 250,000 pound per year at 1998 prices by applying a program of metabolic and nutritional risk factors screening followed by appropriate preventive measures [9] These numbers relate to secondary prevention, aimed at patients with a history of stone formation. Comparing the approaches followed in the different centers they concluded that the best compliance was obtained by giving frequent and clear coaching: “the patients find it easier to adhere to a specific dietary regimen than to general instructions.” a combination of specific instructions and frequent repetition of the dietary counselling seems to provide a good reduction in recurrence
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