title: Evolution of primary care referrals to urology. Impact of a protocol on prostate disease and continuing education.
abstract: OBJECTIVE
  To analyze the evolution of primary care referrals to the Urology Department after the implementation of a joint protocol on prostate disease and a continuing education program in our healthcare area.
  
  
  METHODS
  In January 2011, we launched an action protocol on prostate disease, which was complemented by training sessions and an e-mail-based consultation system. We analyzed primary care referrals to the Urology Department between 2011 and 2013 and determined the reasons for the consultations and the compliance with the established criteria on prostate disease. We obtained data from the "Request for Appointment in Specialized Care" program of the Community of Madrid. We calculated the sample size with a 95% confidence level and a 50% heterogeneity.
  
  
  RESULTS
  A total of 19,048 referrals were conducted. The most common reason for the referrals was lower urinary tract symptoms associated with benign prostate hyperplasia, with a 27% reduction and a compliance that went from 46% at 67%. Although prostate-specific antigen consultations increased by 40%, they improved their appropriateness (from 55% to 72%). This was the main type of consultation for suspicion of malignancy (30%). Also worth mentioning were female incontinence, which doubled in number, and a 41% reduction in erectile dysfunction, which could be due to the primary care training.
  
  
  CONCLUSIONS
  The collaboration between the Department of Urology and primary care succeeded in improving the appropriateness of prostate disease referrals and modified the tendency to refer the rest of the diseases included in the project.
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: raquelsopenasutil@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Sopeña-Sutil
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Tejido-Sánchez
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: M
authors.initials: M
authors.lastname: Galván-Ortiz de Urbina
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: F
authors.initials: F
authors.lastname: Guerrero-Ramos
authors.affiliation: Dirección Asistencial Centro, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: G
authors.initials: G
authors.lastname: García-Álvarez
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: J B
authors.initials: JB
authors.lastname: Passas-Martínez
mesh_terms: D000465:Algorithms; D003663:Decision Trees; D003937:Diagnosis, Differential; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D000069342:Medical Overuse / Q000517:prevention & control*; D058007:Physicians, Primary Care / Q000193:education* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D011320:Primary Health Care / Q000706:statistics & numerical data*; D015397:Program Evaluation; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000150:complications*; D011471:Prostatic Neoplasms / Q000175:diagnosis; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D014549:Urinary Incontinence / Q000453:epidemiology; D052878:Urolithiasis / Q000175:diagnosis / Q000453:epidemiology; D014573:Urology Department, Hospital / Q000706:statistics & numerical data*
chemical_list: D017430:Prostate-Specific Antigen
keywords: Atención Primaria; Benign prostatic hypertrophy; Hiperplasia prostática benigna; PSA; Primary care