Adherence To Recommended Follow-Up Testing Among Patients Prescribed Preventive Pharmacologic Therapy For Urinary Stone Disease

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes Measures II (PD25)1 Sep 2021PD25-01 ADHERENCE TO RECOMMENDED FOLLOW-UP TESTING AMONG PATIENTS PRESCRIBED PREVENTIVE PHARMACOLOGIC THERAPY FOR URINARY STONE DISEASE Joseph Crivelli, Phyllis Yan, Ryan Hsi, and John Hollingsworth Joseph CrivelliJoseph Crivelli More articles by this author , Phyllis YanPhyllis Yan More articles by this author , Ryan HsiRyan Hsi More articles by this author , and John HollingsworthJohn Hollingsworth More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002018.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The AUA’s Medical Management of Kidney Stones guideline outlines specific recommendations on follow-up testing for patients prescribed preventive pharmacologic therapy (PPT). We conducted a study assessing adherence to these recommendations and how adherence relates to subsequent urinary stone disease (USD) events. METHODS: Using claims data from working-age adults with USD (2008 to 2017), we identified patients who were prescribed a PPT agent (i.e., a thiazide diuretic, alkali citrate therapy, allopurinol, or a combination thereof) following completion of a 24-hour urine collection. Among these patients, we measured adherence to three recommendations outlined in the AUA guideline: 1) repeat 24-hour urine collection within six months of PPT prescription, 2) drug class-specific serum testing within six months of PPT prescription, and 3) subsequent 24-hour urine collection within 12 months. We then determined whether patients experienced a USD event (emergency department [ED] visit, hospitalization, or surgery) within three years of PPT receipt. Finally, we fit multivariable logistic regression models, evaluating for an association between USD event occurrence and non-adherence to recommended follow-up testing. RESULTS: Among 1160 patients with USD who were prescribed a PPT agent after a 24-hour urine collection, adherence to individual follow-up testing recommendations outlined in the AUA guideline was low (Table). Follow-up testing varied by drug class prescribed, with 16.7% of patients on allopurinol completing a repeat 24-hour urine collection within six months of initiating therapy, compared to 30.6% of those on combination therapy (P=0.01 for the difference). Non-adherence to guideline recommendations was associated with the occurrence of a USD event. Namely, patients who did not complete a repeat 24-hour urine collection within six months of initial PPT prescription had significantly higher odds of an ED visit, hospitalization, or surgery (odds ratio, 1.69; 95% confidence interval, 1.02 to 2.79). CONCLUSIONS: Most patients prescribed PPT do not receive recommended follow-up testing, which is important because non-adherence was associated with higher odds of a USD event. Source of Funding: National Institutes of Health 1R01DK121709-01A1 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e431-e431 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Crivelli More articles by this author Phyllis Yan More articles by this author Ryan Hsi More articles by this author John Hollingsworth More articles by this author Expand All Advertisement Loading ...