Shared care and the management of lower urinary tract symptoms.
OBJECTIVE
To investigate associations between the level of shared care and the clinical management of patients with uncomplicated lower urinary tract symptoms (LUTS).


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).


CONCLUSIONS
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.
Wolters
Rene
R
Centre for Quality of Care Research (WOK 229), University Medical Centre St Radboud, Nijmegen, the Netherlands. r.wolters@wok.umcn.nl
Wensing
Michel
M
Klomp
Maarten
M
van Weel
Chris
C
Grol
Richard
R
D000553:Ambulatory Care; D003430:Cross-Sectional Studies; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000097:blood / Q000150:complications / Q000628:therapy*; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D016055:Urinary Retention / Q000097:blood / Q000209:etiology / Q000628:therapy*
D017430:Prostate-Specific Antigen