A decision aid for GPs for the treatment of elderly male patients with lower urinary tract symptoms (LUTS).
BACKGROUND
GPs have four main treatment options for lower urinary tract symptoms (LUTS): watchful waiting, alpha-blockers, 5-alpha-reductase inhibitors or (referral for) surgery. Guidelines do not provide clear cut-off values for (combinations of) symptoms and physical examination results to decide which treatment is best.


OBJECTIVE
(i) To develop a decision aid ('checklist') for GPs for the treatment of patients with LUTS. (ii) To assess its value for use in a primary care population. Materials and methods. Population-based cross-sectional study. Included were subjects with uncomplicated LUTS for whom treatment in primary care may be appropriate. [International Prostate Symptom Score (IPSS) > or = 8, no prior prostate surgery, prostate-specific antigen (PSA) value < 10 ng/ml]. For each subject the appropriateness of surgery and alpha-blocker treatment was determined using a previously validated formalized international expert panel judgement. Regression models using data available in primary care were constructed to predict the panel judgement. Subsequently these models were transformed into simple checklists. Finally, the efficiency of these checklists was calculated.


RESULTS
The best checklists consisted of age, symptoms severity, type of symptoms, a quality of life score and PSA value. Assuming one would like to provide at least 95% of the subjects for whom a certain treatment is appropriate with this treatment (i.e. 'sensitivity' of the checklist > or = 95%), one can reach a positive predictive value of 50-60%.


CONCLUSIONS
Simple checklists based on the judgement of experts regarding the most appropriate therapy can help GPs to advise their patients of a rational treatment strategy.
Norg
Roelf J C
RJ
Department of General Practice, Care and Public Health Research Institute, Universiteit Maastricht, Maastricht, The Netherlands. roelf.norg@hag.unimaas.nl
Portegijs
Piet J M
PJ
van de Beek
Kees
K
van Schayck
Onno
O
Knottnerus
J André
JA
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000368:Aged; D015415:Biomarkers / Q000097:blood; D042944:Cholestenone 5 alpha-Reductase / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D005194:Family Practice / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family; D011159:Population Surveillance; D010818:Practice Patterns, Physicians'; D017430:Prostate-Specific Antigen / Q000097:blood; D011788:Quality of Life; D012017:Referral and Consultation; D012107:Research Design; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014570:Urologic Diseases / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D013521:Urologic Surgical Procedures, Male
D000317:Adrenergic alpha-Antagonists; D015415:Biomarkers; D003404:Creatinine; D042944:Cholestenone 5 alpha-Reductase; D017430:Prostate-Specific Antigen