Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA, 02215, USA.
World J Urol. 2021 Mar;39(3):855-860. doi: 10.1007/s00345-020-03261-5. Epub 2020 May 24.
The purpose of this study was to describe the practices of primary care physicians (PCPs) and urologists in their implementation of the 2010 American Urological Association (AUA) recommendations for the management of benign prostatic hyperplasia (BPH) in a nationally representative sample.
Data collected from 2008 to 2015 in the National Ambulatory Medical Care Survey (NAMCS) were used. Men aged 45 and older who presented with either a new complaint or exacerbation of lower urinary tract symptoms (LUTS) were included. Primary outcomes were the prevalence and determinants of prostate-specific antigen (PSA) testing, urinalysis (UA), and digital rectal exam (DRE), as all three were included in the AUA guidelines during the time period studied. In logistic regression analyses weighted to reflect national estimates, potential determinants of adherence for each testing modality were examined.
Between 2008 and 2015, 878 visits met inclusion criteria, corresponding to 14,399,121 ambulatory visits for new or exacerbated LUTS. Weighted prevalence estimates were 24% for PSA testing (95% CI: 19-29%), 61% for urinalysis (95% CI: 56-66%), and 18% for DRE (95% CI: 15-23%). Age ≥ 75 years was associated with lower prevalence of testing for all three tests, and region was associated with different testing estimates for PSA and UA. Patients referred to urologists were more likely to receive a DRE, although overall rates of DRE decreased per additional year of data.
Adherence to AUA guidelines for evaluation of LUTS in ambulatory visits was low in a nationally representative sample of Americans, particularly for PSA testing and DRE, suggesting substantial discordance between guidelines at the time and practice patterns. Practice patterns also differed by age and region. These discrepancies encourage increased education of providers in the implementation of the guidelines, particularly since they have been updated recently.
本研究旨在描述初级保健医生（PCP）和泌尿科医生在全国代表性样本中实施 2010 年美国泌尿外科学会（AUA）关于良性前列腺增生（BPH）管理建议的实践情况。
使用 2008 年至 2015 年在全国门诊医疗调查（NAMCS）中收集的数据。纳入年龄在 45 岁及以上且出现下尿路症状（LUTS）新发作或加重的男性。主要结局是前列腺特异性抗原（PSA）检测、尿液分析（UA）和直肠指检（DRE）的流行率和决定因素，因为在研究期间，所有这三项都包含在 AUA 指南中。在对全国估计值进行加权的逻辑回归分析中，检查了每种检测方式的依从性的潜在决定因素。
2008 年至 2015 年间，878 次就诊符合纳入标准，相当于 14399121 次因新出现或加重的 LUTS 而进行的门诊就诊。加权流行率估计值为 PSA 检测 24%（95%CI：19-29%）、UA 检测 61%（95%CI：56-66%）和 DRE 检测 18%（95%CI：15-23%）。年龄≥75 岁与所有三种检测的检测率降低相关，而地区与 PSA 和 UA 的检测估计值不同相关。转至泌尿科医生处就诊的患者更有可能接受 DRE，尽管随着数据年限的增加，DRE 的总体比率下降。
在一个具有全国代表性的美国人群样本中，对 LUTS 进行门诊评估的 AUA 指南的遵循率较低，特别是对于 PSA 检测和 DRE，这表明当时的指南和实践模式之间存在很大的差异。实践模式也因年龄和地区而异。这些差异鼓励对提供者进行更多关于指南实施的教育，特别是因为最近已经更新了指南。
