UPJ INSIGHT Provider Specialty and Follow-up Testing Among Stone Patients on Preventive Pharmacological Therapy

Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.

UPJ INSIGHT Provider Specialty and Follow-up Testing Among Stone Patients on Preventive Pharmacological Therapy

By: Joseph J. Crivelli, MD, University of Alabama at Birmingham Heersink School of Medicine and Birmingham Veterans Affairs Medical Center, Alabama; Phyllis L. Yan, MA, University of Michigan Medical School, Ann Arbor; Vahakn Shahinian, MD, University of Michigan Medical School, Ann Arbor; Ryan S. Hsi, MD, Vanderbilt University School of Medicine, Nashville, Tennessee; John M. Hollingsworth, MD, MS, NorthShore University Health System, Evanston, Illinois | Posted on: 30 Aug 2023

Crivelli JJ, Yan PL, Shahinian V, Hsi RS, Hollingsworth JM. Associations between provider specialty and use of follow-up testing among patients on preventive pharmacological therapy for urinary stone disease. Urol Pract. 2023;10(4):400-406.

Study Need and Importance

Despite recommendations for repeat 24-hour urine collections and periodic blood testing after initiation of preventive pharmacological therapy for urinary stone disease, there are reasons to believe that adherence to them is low. We examined adherence to these recommendations by provider specialty.

What We Found

Using claims data from working-age adults with urinary stone disease, we identified patients prescribed a preventive pharmacological therapy agent and the specialty of the prescribing physician (urology, nephrology, and general practice). All patients 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 models evaluating associations between prescribing provider specialty and adherence to recommended follow-up testing. Among 2,600 patients meeting study criteria, 1,523 (59%) adhered to ≥1 follow-up testing recommendation. Nephrologists had higher odds of adherence to ≥1 follow-up test compared to urologists (see Table). Significant differences in adherence to the 3 individual guideline recommendations were also observed by specialty.

Table. Multivariable Logistic Regression Model Predicting Odds of Adherence to at Least 1 Guideline-recommended Follow-up Test

Provider specialty	Odds ratio	95% confidence interval	P value
Urology	Ref.
Nephrology	1.52	1.19 to 1.94	< .01
General/IM	1.05	0.80 to 1.38	.71
Abbreviations: IM, internal medicine; Ref., reference.

Limitations

Study limitations include: (1) limited generalizability to other populations such as uninsured or older adults, (2) residual confounding and omitted variable bias, (3) possible inclusion of patients prescribed pharmacotherapy for other indications (ie, hypertension and gout), (4) serum testing performed for reasons other than kidney stone follow-up, and (5) no available data regarding kidney stone composition and abnormal findings on 24-hour urine analyses.

Interpretation for Patient Care

There are significant differences between specialties in prescription of preventive pharmacological therapy and adherence to guideline-recommended follow-up testing. Overall adherence to such testing was low. This may be an area for future quality improvement initiatives.