PURPOSE: Secondary prevention plays an important role in urinary stone disease.
The core of secondary prevention is the identification of modifiable risk factors with a 24-hour urine collection, which then directs selective medical therapy. While this has been shown to reduce recurrence rates, little is known about the frequency with which 24-hour urine collections are obtained.
MATERIALS AND METHODS: Using medical claims (2002 to 2006), we identified adults with incident urinary stone episodes. With appropriate diagnosis codes, we determined those that were at high risk for recurrence. Among these patients, we determined the proportion that collected a 24-hour urine collection within six months of diagnosis. Finally, we fitted regression models to measure associations between patient- and provider-level factors and obtaining a 24-hour urine collection.
RESULTS: In total, 28,836 patients at high risk of recurrence were identified. The prevalence of 24-hour urine testing rose from 7.0% in 2003 to 7.9% in 2006 (P=0.011), but the overall prevalence was exceedingly low at 7.4%. Multivariable regression revealed region of residence and level of comorbid illness to be independently associated with 24-hour urine collection, as was the type of physician performing the follow up. For instance, odds of metabolic evaluation were 2.9 times higher if a patient was seen by a nephrologist (OR, 2.92, 95% CI, 2.32 - 3.67) and over three-fold higher if he/she was seen by a urologist (OR, 3.87; 95% CI, 3.48 - 4.30).
CONCLUSION: Obtaining 24-hour urine collections in high-risk stone formers is uncommon, raising a quality of care concern.
Written by:
Milose JC, Kaufman SR, Hollenbeck BK, Wolf JS Jr, Hollingsworth JM. Are you the author?
University of Michigan, Department of Urology, Divisions of Endourology and Health Services Research.
Reference: J Urol. 2013 Sep 6. pii: S0022-5347(13)05327-5.
doi: 10.1016/j.juro.2013.08.080
PubMed Abstract
PMID: 24018242
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