Sanchez DE, Low J, Lucas MI, et al. eConsult provides a novel opportunity to evaluate hematuria referrals for Medicaid patients in the “real-world” community. Urol Pract. 2023;10(3):236-243.

Study Need and Importance

Uninsured or low-income patients experience longer delays in hematuria evaluation and treatment. This disparity contributes to higher mortality rate from bladder cancer in underserved populations. Prior studies report that the use of eConsults increases efficiency of care in underserved populations. There is a need to understand the appropriateness and completeness of hematuria evaluation in Medicaid patients.

What We Found

Most Medicaid patients in community health systems do not receive the recommended hematuria evaluation and workup per AUA guidelines. Primary care provider evaluation for risk factor rates prior to eConsult were low (see Table). Over two-thirds of the patients were referred without a documented urinalysis with microscopy or history of gross hematuria. Most patients did not have computerized tomographic urography ordered or completed at the time of eConsult dialogue completion, despite the 2012 AUA Guideline recommendation. Only half of all referrals were deemed appropriate based on a history of gross hematuria or ≥3 red blood cells/high-power field on urinalysis. Over three-quarters of the patients who met documented hematuria criteria compared to one-third of the patients who did not meet documented hematuria criteria ended in a face-to-face (FTF) urologist visit recommendation. By the conclusion of the eConsult only half of the patients were referred for an FTF visit.

Limitations

This study was conducted via retrospective data collection. Furthermore, our analysis only includes information available at the time of the original eConsult and final iterative dialogue outcome. We do not have follow-up information and cannot determine whether these patients eventually obtained the appropriate workup, imaging, or procedures.

Interpretation for Patient Care

eConsult dialogues can be used to assess quality of care and improve information dissemination of guidelines to community primary care providers. Thus, eConsults can be used as a teaching tool to improve the completeness of hematuria evaluation in underserved settings and minimize unnecessary FTF urologist referrals.