Associations Between Provider Specialty and Use of Follow-up Testing Among Patients on Preventive Pharmacological Therapy for Urinary Stone Disease.
Associations Between Provider Specialty and Use of Follow-up Testing Among Patients on Preventive Pharmacological Therapy for Urinary Stone Disease.
复制标题
提供者专业与尿路结石预防性药物治疗患者随访测试使用之间的关联。
DOI：
10.1097/upj.0000000000000414
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发表时间：
2023
期刊：
影响因子：
0.8
通讯作者：
Hollingsworth,JohnM
中科院分区：
文献类型：
--
作者：
Crivelli,JosephJ;Yan,PhyllisL;Shahinian,Vahakn;Hsi,RyanS;Hollingsworth,JohnM
AUA肾结石医疗管理指南概述了对接受预防性药物治疗的患者进行随访检测的建议。我们评估了遵守这些建议的供应商speciality.MethodsUsing索赔数据从工作年龄的成年人泌尿系结石病（2008-2019年），我们确定了患者规定的预防性药物治疗剂（噻嗪类利尿剂，碱柠檬酸盐治疗，别嘌呤醇，或其组合）和专业的处方医生（泌尿科，肾脏科，和一般做法）。接下来，我们确定了在处方填写前完成24小时尿液收集的患者。然后，我们测量了对AUA指南中概述的3项建议的依从性。最后，我们拟合多变量logistic回归模型，评估处方提供者的专业和遵守建议的后续testing.ResultsAmong 2,600例患者符合研究标准，1,523（59%）坚持≥1个后续测试的建议，在研究期间显着增加。与泌尿科医生相比，肾病科医生坚持≥1次随访检查的几率更高（比值比，1.52; 95%置信区间，1.19-1.94;P< .01）。3个人的指导方针的建议，遵守显着差异也观察specialty. ConclusionsAfter开始预防性药物治疗，遵守指南建议的后续测试是低的整体。在使用该测试时存在有意义的专业特定差异。
IntroductionThe 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.MethodsUsing 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.ResultsAmong 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.ConclusionsFollowing 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.