title: Differences in initial benign prostatic hyperplasia management between primary care physicians and urologists.
abstract: OBJECTIVE
  The introduction of efficacious pharmacotherapies has effectively transformed benign prostatic hyperplasia into a chronic disease that requires ongoing medical care. With this transformation primary care physicians have become more involved in the management of benign prostatic hyperplasia. The impact of the increasing role of the primary care physician on the use of benign prostatic hyperplasia related health services remains unknown.
  
  
  METHODS
  We performed a retrospective cohort study using medical claims from a nonprofit managed care organization. Between 1997 and 2005 we identified incident cases of benign prostatic hyperplasia and the provider responsible for the initial care. We fitted logistic regression models to measure the association between subject receipt of an evaluative process and the treating physician specialty. Furthermore, we examined differences between primary care physicians and urologists with respect to the use of medical therapy.
  
  
  RESULTS
  Less than a third of incident cases received initial care from a urologist. Use of office based procedures and urodynamic tests was exclusive to urology. Urologists performed urinalysis testing and transrectal ultrasonography more frequently than primary care physicians (p <0.001). The odds of having a laboratory study doubled with treatment by a urologist (OR 2.03, 95% CI 1.51-2.74). Men seen by a urologist were also more likely to be prescribed a benign prostatic hyperplasia medication (p <0.001). Among those who received medical therapy, prescription of selective alpha-adrenergic blockers, 5alpha-reductase inhibitors and combination therapy was higher among urologists (p = 0.002).
  
  
  CONCLUSIONS
  On average, urologists had a higher intensity practice style for benign prostatic hyperplasia than primary care physicians. Further studies are needed to determine how these practice style differences relate to patient clinical outcomes.
authors.affiliation: Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, Michigan 48109-0604, USA. kinks@med.umich.edu
authors.forename: John M
authors.initials: JM
authors.lastname: Hollingsworth
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
authors.forename: Stephanie
authors.initials: S
authors.lastname: Daignault
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011470:Prostatic Hyperplasia / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies; D014572:Urology