| Understanding the barriers to the dissemination of medical expulsive therapy. | |
| | |
MedLine Citation:
|
PMID: 20952037 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
PURPOSE: Increasing trial evidence suggests that a course of medical expulsive therapy is warranted for patients with ureteral stones who are amenable to conservative treatment, and that this efficacious process of care is underused. To better understand the barriers to the dissemination of medical expulsive therapy we analyzed health care claims of working age adults with urinary stone disease. MATERIALS AND METHODS: Using MarketScan® data (2002 to 2006) we identified patients with urinary stone disease who were treated in the emergency department. We characterized differences between patients who were prescribed medical expulsive therapy and those who were not. After assigning patients to their principal providers we determined how much of the variation in medical expulsive therapy prescribing rates was attributable to patient vs provider level factors. RESULTS: A total of 79,688 patients were seen for an acute stone episode. They received care from 12,328 providers. In general those patients prescribed medical expulsive therapy tended to be older (p<0.001) and were more likely male (p<0.001). A higher percentage of medical expulsive therapy recipients were salaried (p=0.003) and had full-time employment (p<0.001). Of the unexplained variation in medical expulsive therapy prescription 21% was accounted for by unmeasured provider factors and patient odds of receiving medical expulsive therapy were 5-fold higher if seen by a urologist (OR 4.94, 95% CI 2.96-8.28, p<0.001). CONCLUSIONS: These data reveal that the provider seen for an episode of renal colic substantially determines whether the patient will receive medical expulsive therapy. As such, an educational intervention directed toward emergency department physicians might hasten the uptake of medical expulsive therapy within the broader medical community. |
| | |
Authors:
|
John M Hollingsworth; J Stuart Wolf; Gary J Faerber; William W Roberts; Rodney L Dunn; Brent K Hollenbeck |
Related Documents
:
|
21563007 - Selling medical travel to us patient-consumers: the cultural appeal of website marketin... 10997217 - Duodenal ulcer disease: treatment by surgery, antibiotics, or both. 16417067 - Medications for migraine prophylaxis. 7954757 - Assessment of international headache society diagnostic criteria: a reliability study. 17854517 - Natural cycle ivf: a question of semantics? 2399997 - The clinical presentation of command hallucinations in a forensic population. |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-10-16 |
Journal Detail:
|
Title: The Journal of urology Volume: 184 ISSN: 1527-3792 ISO Abbreviation: J. Urol. Publication Date: 2010 Dec |
Date Detail:
|
Created Date: 2010-11-12 Completed Date: 2010-12-30 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0376374 Medline TA: J Urol Country: United States |
Other Details:
|
Languages: eng Pagination: 2368-72 Citation Subset: AIM; IM |
Copyright Information:
|
Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved. |
Affiliation:
|
Robert Wood Johnson Foundation Clinical Scholars Program, Department of Urology, University of Michigan, Ann Arbor, Michigan 48105-2967, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Adult Drug Utilization / statistics & numerical data Female Humans Male Middle Aged Physician's Practice Patterns Urinary Calculi / drug therapy* Young Adult |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Management of surgical and radiation induced rectourethral fistulas with an interposition muscle fla...
Next Document: PCDD/Fs in sediments of Central Vietnam coastal lagoons: in search of TCDD.