Are patients with hematuria appropriately referred to Urology? A multi-institutional questionnaire based survey
Alan M Nieder1, Yair Lotan, Geoffrey R Nuss
1Department of Urology, University of Miami, Miller School of Medicine, Miami, FL 33136, USA. alan.nieder@columbia.edu
Insights
Primary care physicians often use urinalysis but under-refer patients with microscopic hematuria for urologic evaluation. Timely referrals are crucial for diagnosing serious conditions like bladder cancer.
Area of Science:
- Urology
- Primary Care Medicine
- Medical Practice Patterns
Background:
- Hematuria, a common sign of urologic disease, necessitates evaluation per AUA guidelines.
- Guidelines recommend urologic assessment for both microscopic and gross hematuria.
- Practice patterns of primary care physicians (PCPs) in hematuria evaluation are not well-understood.
Purpose of the Study:
- To assess the practice patterns of PCPs regarding hematuria evaluation.
- To determine referral rates for microscopic and gross hematuria.
- To identify potential gaps in care for patients with hematuria.
Main Methods:
- Anonymous surveys distributed to 2,501 PCPs in Miami and Dallas.
- Physicians surveyed included internal medicine, family practice, primary care, and OB/GYN.
- Questions focused on urinalysis use and hematuria referral practices.
Main Results:
- 788 PCPs completed surveys (46% Miami, 26% Dallas).
- Screening urinalysis was common (77% Miami, 64% Dallas).
- Only 36% of PCPs referred microscopic hematuria; 77% (Miami) and 69% (Dallas) referred gross hematuria.
Conclusions:
- PCPs frequently utilize urinalysis but under-refer microscopic hematuria cases.
- Referral rates for gross hematuria are higher but not universal.
- Further research is needed to understand referral patterns and improve timely evaluation to prevent delays in diagnosing conditions like bladder cancer.
Introduction:
Hematuria is a common finding that may be a sign of serious underlying urologic disease. Thus, the AUA guidelines (written in conjunction with the American Academy of Family Practice) recommend urologic evaluation for patients with both microscopic and gross hematuria. We sought to evaluate practice patterns of the evaluation of hematuria by primary care physicians (PCPs) in two locations in the United States.
Methods:
Anonymous questionnaires regarding use of urinalysis (UA) and evaluation of hematuria were mailed to 586 PCPs in Miami, Florida and 1,915 in Dallas, Texas. Surveys were mailed to physicians who identified themselves as practitioners of internal medicine, family practice, primary care, or obstetrics and gynecology.
Results:
Surveys were completed by 788 PCPs including 270 (46%) and 518 (26%) PCPs in Miami and Dallas, respectively. Screening UAs were obtained on all patients by 77% and 64%, of physicians in Miami and Dallas, respectively. In both Miami and Dallas, only 36% of PCPs reported referring patients with microscopic hematuria to an urologist. In patients with gross hematuria, referral rates were 77% and 69% in Miami and Dallas, respectively.
Conclusions:
While many PCPs use UA in many of their patients routinely, few PCPs automatically refer their patients with microscopic hematuria to urology and not all patients with gross hematuria are referred. Further investigations regarding why and when patients are referred to urology is warranted. Increasing awareness of the complete and timely evaluation of hematuria may be beneficial in preventing a delay in bladder cancer.
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