Login to Access Video or Poster Abstract: MP90-17
Sources of Funding: None

Introduction

Many patients with symptomatic or recurrent stones are evaluated and treated solely in the primary care setting. While the American College of Physicians and American Urological Association have guidelines to assist in the management of stone patients, substantial differences exist in the recommendations. We sought to characterize the care of stone patients within a cohort of primary care providers to better understand practice patterns and determine factors influencing urologic referral.

Methods

We surveyed primary care providers attending a regional internal medicine conference in March 2016. Participants were questioned regarding their practice with stone patients in respect to acute symptoms, routine surveillance and metabolic evaluation / prevention. Responses were compared using appropriate statistical measures.

Results

Of 147 (43%) respondents, the mean age was 52 years (range 27?86). 79% of the cohort were physicians. 87% of providers noted routine treatment of stone patients while 68% expressed comfort with their care delivery. For acute colic, imaging was obtained by 87%. 41% routinely used alpha blockers for medical expulsive therapy which was most associated with physicians and older providers (p<0.007). For recurrent stones, surveillance imaging was ordered in 21%. When available, stone analysis was performed by 39% and most associated with older providers (p<0.002). 24 hour urine studies were ordered by only 12%. Thiazides, alkali citrate and allopurinol were routinely prescribed for preventive measures at equal frequencies by 38% of respondents and more commonly by those with increased comfort treating stone patients (p=0.003). Of providers using preventive medications, therapy was empiric in 79%. However, use of thiazides and allopurinol was associated with those ordering urine studies (p<0.004). Routine urologic referral was cited by 52% for acute symptoms, 31% for routine surveillance and 22% for metabolic prevention. Patient factors most associated with prompting referral included stone size (84%), pain symptoms (74%) and urinary symptoms (68%).

Conclusions

Kidney stone disease is a common complaint in the primary care setting. In our cohort, there was variable use of routine measures including imaging, stone analyses, urine studies and preventive medications. This highlights the importance of improved collaboration for developing uniform stone guidelines. Future studies are needed to confirm differences in patient care based on specialty and may assist in establishing baseline shared treatment pathways and detailed indications for urologic referral.

Funding

None