NEW ORLEANS, LA USA (UroToday.com) - In this podium presentation, the authors presented data from a study performed out of the University of Pennsylvania examining primary care providers’ awareness of and adherence to the AUA guidelines on hematuria in caring for patients presenting with gross or microscopic hematuria. To accomplish this objective, the authors sent out an electronic survey to all 574 attending physicians, fellows, residents, and advanced practice providers from the internal medicine, family medicine and emergency medicine departments within a single academic health system. In total 24% of those sent the survey ultimately completed it. The authors found that only 13% of respondents were aware of the AUA guidelines on asymptomatic microscopic hematuria. In addition, only 30% of respondents appropriately identified the current correct definition for asymptomatic microscopic hematuria. With regards to diagnostics, 65% of respondents stated they would not order a urine cytology, which is in line with the guidelines.
The authors reported that 53% of providers stated they would only image the patient if there were additional reasons to do so, and 21% stated they would not obtain imaging, both of which are clear deviations from the AUA recommendations and, thus, place patients at risk for missed disease. Of those who said they would obtain imaging, the authors found that respondents were just as likely to order a CT without/with contrast as they were to order a renal ultrasound.
They also found that referral of all patients with hematuria for urological consultation occurred in just the minority of patients. Only 46% of respondents stated they would refer patients to a urologist for any degree of hematuria; 10% would only do it in the setting of asymptomatic microhematuia, and 38% only in the setting of gross hematuria. The authors reported that 7% of respondents stated they would never refer a patient with hematuria to a urologist.
Given the findings of the study, it is not surprising that 93% of the providers interviewed agreed that a clinical pathway derived from findings in the literature, addressing patients presenting with hematuria, would be helpful. Dr. Parrillo emphasized the importance of collaborative efforts between urologists and primary care providers to educate as well as to ensure that any care being delivered to these patients is optimal and uniform.
Presented by Lisa Parrillo, MD at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
Penn Medicine, Philadelphia, PA USA
Reported by Timothy Ito, MD, medical writer for UroToday.com