Clements Matthew B, Lin Xin, Gmelich Caroline, Vertosick Emily A, Vickers Andrew J, Manasia Michael K, Wolchasty Natalie C, Scardino Peter T, Eastham James A, Laudone Vincent P, Touijer Karim A, Ehdaie Behfar
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Advanced Practice Providers, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Urol Pract. 2021 Sep;8(5):535-540. doi: 10.1097/upj.0000000000000249. Epub 2021 Sep 1.
We implemented an advanced practice provider (APP)-led clinic to aid in managing the growing population of men on active surveillance (AS) for prostate cancer. Our objective was to evaluate the quality and safety of an established APP-led AS clinic by comparing outcomes with urologist-led biopsies, defined in terms of adherence to scheduled visits and biopsy complications.
We performed a retrospective review of 2341 consecutive patients treated in an AS clinic at a high-volume referral center between 2000-2019. We examined the rate of no-show or same-day cancellation of visits for APPs versus urologists and compared the risk of biopsy complications between these providers. Generalized estimating equations were used to account for repeated visits and biopsies.
There were significantly more no-shows at APP visits (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.16-1.70, <0.001); however, this only amounted to one no-show every 41 visits. There was no evidence of increased biopsy complications with APPs (OR 0.37, 95% CI 0.05-2.49, =0.3). Patients were not prospectively assigned to APP or urologist management; therefore, unmeasured patient differences could bias our results.
We demonstrated that in an established APP-led AS clinic at a high-volume center, APPs achieved acceptable patient adherence to scheduled visits and biopsy complications. Because patients were not continuously managed by one type of provider, further prospective studies are needed to establish equivalent pathologic outcomes in APP-managed AS.
我们设立了一个由高级执业医师（APP）主导的诊所，以协助管理日益增多的接受前列腺癌主动监测（AS）的男性患者群体。我们的目标是通过比较与泌尿科医生主导的活检结果（以遵守预约就诊情况和活检并发症来定义），评估一个成熟的由APP主导的AS诊所的质量和安全性。
我们对2000年至2019年期间在一家大型转诊中心的AS诊所接受治疗的2341例连续患者进行了回顾性研究。我们检查了APP与泌尿科医生的就诊未到或当日取消就诊的比率，并比较了这些医疗服务提供者之间活检并发症的风险。使用广义估计方程来考虑重复就诊和活检情况。
APP就诊时的未到情况显著更多（优势比[OR]为1.40，95%置信区间[CI]为1.16 - 1.70，P<0.001）；然而，这仅相当于每41次就诊中有1次未到。没有证据表明APP导致活检并发症增加（OR为0.37，95% CI为0.05 - 2.49，P = 0.3）。患者并非前瞻性地被分配到APP或泌尿科医生管理组；因此，未测量的患者差异可能会使我们的结果产生偏差。
我们证明，在一家大型中心的成熟的由APP主导的AS诊所中，APP实现了患者对预约就诊的可接受依从性以及活检并发症情况。由于患者并非由单一类型的医疗服务提供者持续管理，因此需要进一步的前瞻性研究来确定APP管理的AS中同等的病理结果。
