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UPJ INSIGHT Integrated Urology and Primary Care Model Improves Outcomes for Men With Testosterone Deficiency

By: Vi Nguyen, MD, University of California, San Diego; Susana E. Berrios, MD, University of California, San Diego; Austin Leonard, MD, University of California, San Diego; Eileen R. Byrne, MD, Mayo Clinic, Rochester, Minnesota; Darshan P. Patel, MD, University of California, San Diego; Leslie Martin, MD, University of California, San Diego; Tung-Chin Hsieh, MD, MBA, University of California, San Diego | Posted on: 15 Dec 2023

Nguyen V, Berrios SE, Leonard A, et al. Integrated urology and primary care model improves outcomes for men with testosterone deficiency. Urol Pract. 2023;10(6):673-678.

Study Need and Importance

Many men presenting with testosterone deficiency do not have access to a primary care provider (PCP). We sought to integrate primary care into initial urological evaluation to better identify and manage undertreated comorbidities.

What We Found

Eighty-one men were evaluated over the 3-year study period (Figure); 41% did not have a preexisting PCP. Older men were significantly more likely to have a preexisting PCP (OR 1.06 [95% CI: 1.02-1.10], P < .001). Hispanic men were significantly less likely to have a PCP (OR 0.16 [95% CI: 0.03-0.84], P = .01). Fifty-nine percent established continuity of care. Newly diagnosed comorbidities included hypertension (41%), obesity (37%), hyperlipidemia (27%), obstructive sleep apnea (25%), depression (23%), and diabetes (14%). Fifty-one percent were prescribed a new medication. Twenty-six percent were referred to nutrition, with a mean BMI decrease of 1.75 kg/m2. Thirty-two percent underwent sleep medicine evaluation for obstructive sleep apnea. Thirty-three percent and 46% received flu vaccinations and immunization updates. Fourteen percent were referred for screening colonoscopy.

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Figure. Outcomes gained from integrated urology and primary care model for men with testosterone deficiency. BMI indicates body mass index; OSA, obstructive sleep apnea; PCP, primary care provider; T, testosterone.

Limitations

Our analysis was conducted in a retrospective manner at a single institution. Further studies are needed to assess reproducibility and cost-effectiveness of this model. Our study population was predominantly White; increased sample size and resultant racial diversity may offer more insight into ethnic disparities of health outcomes among men with testosterone deficiency.

Interpretation for Patient Care

It is long believed that urologists often serve as PCPs for the aging male. Furthermore, with emergence of direct-to-consumer men’s health services, several men bypass seeing the urologist. These approaches represent a missed opportunity given the benefits garnered when men are evaluated in a multidisciplinary manner. This is the first report of integrated primary care and urology evaluation for testosterone deficiency. Our comprehensive model results in improved outcomes including increased access to subspecialty referrals, objective weight loss, treatment of new diagnoses, updated immunizations, and cancer screening.

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