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Publication year
2004Source
BJU International, 94, 9, (2004), pp. 1287-90ISSN
Publication type
Article / Letter to editor
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Organization
IQ Healthcare
General Practice
Former Organization
Centre for Quality of Care Research
Journal title
BJU International
Volume
vol. 94
Issue
iss. 9
Page start
p. 1287
Page end
p. 90
Subject
EBP 3: Effective Primary Care and Public Health; EBP 4: Quality of CareAbstract
OBJECTIVE: To investigate associations between the level of shared care and the clinical management of patients with uncomplicated lower urinary tract symptoms (LUTS). SUBJECTS AND METHODS: A cross-sectional survey study was conducted comprising all urologists and a random selection of general practitioners (GPs) in the Netherlands. Questionnaire responses were obtained from 182 urologists (70%) and 261 GPs (55%). The first part of the questionnaire established the physicians' characteristics and the second the level of familiarity with the national shared-care guidelines, arrangements between urologists and GPs, and the availability of a shared-care prostate clinic. The third part presented a written case of a 50-year-old man with clinical uncomplicated LUTS, and asked questions about diagnostic and therapeutic care. RESULTS: The clinical management of LUTS by GPs and urologists differed, particularly for diagnostic procedures. Only a minority of GPs (8%) and urologists (18%) had a shared-care clinic at their disposal. Such clinics were associated with an increase in tests ordered by the GP, e.g. creatinine levels (odds ratio, OR 3.83) and PSA levels (OR 5.93), and a decrease in choosing a watchful-waiting strategy for patients with mild symptoms (OR 0.24). Furthermore, urologists more often chose surgical intervention for moderate symptoms (OR 9.80). CONCLUSION: A shared-care clinic may lead to a shift in primary care towards the working style of urologists. This healthcare may not be as cost-effective as expected by policy makers. Prospective studies are needed to provide better insight in the health outcomes and efficiency of shared-care clinics.
This item appears in the following Collection(s)
- Academic publications [238441]
- Electronic publications [122527]
- Faculty of Medical Sciences [90373]
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