Department of Urology, University of Michigan and i3 Drug Safety, Ann Arbor, Michigan 48109-2800, USA.
J Urol. 2011 Sep;186(3):971-6. doi: 10.1016/j.juro.2011.04.081. Epub 2011 Jul 24.
We examined the evaluation of and management for lower urinary tract symptoms/benign prostatic hyperplasia by physician specialty (urologist vs primary care physician).
The BPH Registry and Patient Survey is a longitudinal, observational, disease registry cohort of patients enrolled from January 2004 to February 2005 in the United States. The survey examines patient outcomes and physician practice patterns in the management of lower urinary tract symptoms associated with clinical benign prostatic hyperplasia. It includes 402 urologist and primary care physician practices throughout the United States. Included in this study were 6,924 men with lower urinary tract symptoms/benign prostatic hyperplasia managed by watchful waiting or medical therapy. Data were collected on demographics, clinical characteristics and lower urinary tract symptoms/benign prostatic hyperplasia management using physician and patient completed forms. Multivariate analysis was done by physician specialty.
Based on multivariate analysis urologists were more likely than primary care physicians to perform urinalysis (OR 3.9), serum prostate specific antigen (OR 1.2) and post-void residual urine (OR 18.9) measurement, uroflowmetry (OR 17.3), prostate ultrasound (OR 7.7) and biopsy (OR 3.5), renal ultrasound (OR 4.0) and cystoscopy (OR 4.6) but less likely to measure creatinine (OR 0.1). Men seeing urologists were twice as likely as men seeing primary care physicians to be treated with benign prostatic hyperplasia medical therapy vs watchful waiting. Significant differences by physician specialty were also observed for specific benign prostatic hyperplasia medical therapies.
Significant differences in practice patterns were observed between primary care physicians and urologists in the evaluation of and management for lower urinary tract symptoms/benign prostatic hyperplasia. These data establish valuable benchmarks and identify possible interventions that may improve the standard of care.
我们考察了医生专业（泌尿科医生与初级保健医生）对下尿路症状/良性前列腺增生的评估和治疗管理。
BPH 登记和患者调查是一项在美国于 2004 年 1 月至 2005 年 2 月期间进行的纵向、观察性、疾病登记队列研究，该研究调查了下尿路症状与临床良性前列腺增生相关的患者结局和医生治疗模式。该研究包括美国各地的 402 个泌尿科医生和初级保健医生诊所。本研究共纳入 6924 名接受观察等待或药物治疗的下尿路症状/良性前列腺增生患者。使用医生和患者填写的表格收集人口统计学、临床特征和下尿路症状/良性前列腺增生管理数据。采用多元分析方法对医生专业进行分析。
基于多元分析，泌尿科医生比初级保健医生更有可能进行尿液分析（OR 3.9）、血清前列腺特异抗原（OR 1.2）和残余尿（OR 18.9）测量、尿流率（OR 17.3）、前列腺超声（OR 7.7）和活检（OR 3.5）、肾脏超声（OR 4.0）和膀胱镜检查（OR 4.6），但不太可能测量肌酐（OR 0.1）。与初级保健医生就诊的男性相比，泌尿科医生就诊的男性接受良性前列腺增生药物治疗的可能性是观察等待的两倍。医生专业之间也观察到特定良性前列腺增生药物治疗的显著差异。
在对下尿路症状/良性前列腺增生的评估和治疗管理方面，初级保健医生和泌尿科医生之间存在显著的实践模式差异。这些数据确立了有价值的基准，并确定了可能改善治疗标准的干预措施。
