title: Improving initial management of lower urinary tract symptoms in primary care: costs and patient outcomes.
abstract: OBJECTIVE
  Guidelines for primary care management of lower urinary tract symptoms in older men recommend shared decision making regarding the choice of treatment. In this study we aimed to determine the costs and patient outcomes of an implementation strategy designed to enhance uptake of these guidelines.
  
  
  METHODS
  The intervention comprised a distance learning programme for general practitioners, comprising evidence-based information, assessment of learning needs, a knowledge test and patient education materials. The control group only received the written guidelines. A cluster randomized trial in 187 older male patients compared costs and outcomes in the two study groups. A healthcare perspective was taken in the economic evaluation, with a 3-month time horizon. The primary health outcome was patient-reported urinary symptoms at 3 months. Costs relating to the distance learning package and the healthcare provided were considered, using undiscounted standardized prices.
  
  
  RESULTS
  Patient-reported urinary symptoms at 3 months did not differ between the study groups: 66% and 61% with moderate symptoms and 7% and 11% with severe symptoms in the intervention and control groups, respectively. The mean total costs per patient were euro28.15 lower in the intervention group (euro93.11) compared to the control group (euro121.26), mainly because of a lower number of referrals to the urologist. A bootstrap analysis showed an incremental cost-effectiveness ratio of euro111.98 (95% CI -euro423 to +euro329).
  
  
  CONCLUSIONS
  The distance learning programme did not change health outcomes, but it reduced costs in the first 3 months after an initial consultation compared to written guidelines. Studies with a longer follow-up period are needed.
authors.affiliation: Centre for Quality of Care Research (WOK), Department of General Practice, Radboud University Nijmegen Medical Centre, The Netherlands.
authors.forename: René
authors.initials: R
authors.lastname: Wolters
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
authors.forename: Tjard
authors.initials: T
authors.lastname: Schermer
authors.forename: Reinier
authors.initials: R
authors.lastname: Akkermans
authors.forename: Rosella
authors.initials: R
authors.lastname: Hermens
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D019468:Disease Management; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics*; D011320:Primary Health Care / Q000191:economics*; D016032:Randomized Controlled Trials as Topic; D014570:Urologic Diseases / Q000191:economics* / Q000628:therapy*