Diagnosis and treatment of benign prostatic hyperplasia - Practice patterns of primary care physicians
Diagnosis and treatment of benign prostatic hyperplasia - Practice patterns of primary care physicians
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DOI：
10.1007/s11606-006-5044-2
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发表时间：
1997-04-01
影响因子：
5.7
通讯作者：
Fowler, FJ
中科院分区：
文献类型：
--
作者：
Collins, MM;Barry, M;Fowler, FJ
目的：定义初级保健医生（PCP）管理良性前列腺增生（BPH）患者的实践，并将这些实践与美国卫生保健政策和研究局BPH指南和泌尿科医生的实践进行比较。设计：邮件调查。参与者：从美国医学会注册处选择的全国范围内随机抽样的PCP和泌尿科医生。第一次邮寄，明信片提醒，第二次邮寄，电话提醒，最后一次邮寄。初级保健医生（n = 444，应答率= 51%）报告在前一年中看到了35例BPH患者，而泌尿科医生为240例（n = 394，响应= 68%）。关于指南推荐的测试，三分之二的PCP报告很少或从不使用美国泌尿学会（AUA）症状指数，几乎所有人都报告常规进行直肠指检，许多人（66%）报告常规订购测试以确定血清肌酐水平，尽管指南认为“可选”，超过90%的PCP报告定期订购前列腺特异性抗原检测，而很少使用其他可选检测。关于“不推荐”的研究，相当一部分人报告选择性地或常规地进行静脉肾盂造影（34%）和肾脏超声（33%），而三分之二的人报告很少或从不进行这些检查。86%的PCP报告在过去一年中为BPH开了处方药; α受体阻滞剂的中位数为12例，芬普胺的中位数为2例。泌尿外科转诊阈值的变化，建议在两个病人scenarios.CONCLUSIONS：初级保健医生积极管理BPH患者。他们的一些诊断评估与国家指南和泌尿科医生实践的建议不同。转诊门槛似乎差别很大。
OBJECTIVE: To define primary care physicians' (PCPs) practices in managing patients with benign prostatic hyperplasia (BPH), and to compare these practices to portions of the Agency for Health Care Policy and Research BPH guideline and urologists' practices.DESIGN: Mail survey.PARTICIPANTS: Nationwide random sample of PCPs and urologists, selected from the American Medical Association Registry.METHODS: Initial mailing, postcard reminder, second mailing, telephone reminder, final mailing.MAIN RESULTS: Primary care physicians (n = 444, response = 51%) reported seeing a median of 35 patients with BPH over the preceding year, in contrast to 240 for urologists (n = 394, response = 68%). Regarding tests recommended by the guideline, two thirds of PCPs reported rarely or never using the American Urological Association (AUA) symptom index, nearly all reported routinely performing digital rectal examinations, and many (66%) reported routinely ordering tests to determine the serum creatinine level, Although considered ''optional'' by the guideline, more than 90% of PCPs reported routinely ordering a prostate-specific antigen test, while infrequently using other optional tests. Regarding ''not recommended'' studies, a substantial minority reported selectively or routinely ordering intravenous pyelography (34%) and renal ultrasound (33%), while two thirds reported rarely or never ordering these tests. Eighty-six percent of PCPs reported prescribing medications for BPH over the preceding year; alpha blockers to a median of 12 patients, and finasteride to a median of 2. Variation in urology referral thresholds was suggested in responses to two patient scenarios.CONCLUSIONS: Primary care physicians are actively managing patients with BPH. Some of their diagnostic evaluations vary from the recommendations of a national guideline and urologists' practices. Referral thresholds appear to vary considerably.