What is evaluation of hematuria by primary care physicians? Use of electronic medical records to assess practice patterns with intermediate follow-up

Anna Buteau, Casey A. Seideman, Robert S. Svatek, Ramy F. Youssef, Gaurab Chakrabarti, Gary Reed, Deepa Bhat, Yair Lotan

    Research output: Contribution to journalArticle

    38 Scopus citations

    Abstract

    Background: To determine whether patients found to have hematuria by their primary care physicians are evaluated according to best practice policy. Materials and methods: The University of Texas Southwestern Medical Center maintains institutional outpatient electronic medical records (EMR) that are used by all providers in all specialties. We conducted an Institutional Review Board approved observational study of patients found to have more than 5 red blood cells/high power field between March 2009 and February 2010. Results: There were 449 patients of whom the majority were female (82%), Caucasian (39%), with microscopic hematuria (MH) (85%). Almost 58% of patients were initially symptomatic with urinary symptoms or pain. Evaluation for the source of hematuria was limited and included imaging (35.6%), cystoscopy (9%, and cytology (7.3%). Only 36% of men and 8% of women were referred to a urologist. No abnormality was found in 32% and 51% of patients with gross hematuria and MH, respectively (P = 0.004). There were 4 bladder tumors and 1 renal mass detected. Male gender, ethnicity and gross (vs. microscopic) hematuria were associated with higher rate of urological referral. Advanced age, smoking, provider practice type, and the presence of urinary symptoms were not associated with an increase rate of urological referral. No additional cancers were diagnosed with 29-month follow-up. Conclusions: While urinalysis remains a common diagnostic tool, most cases of both microscopic and gross hematuria are not fully evaluated according to guidelines. Use of cystoscopy, cytology, and upper tract imaging is limited. Further studies will be needed to determine the extent of the problem and impact on morbidity and survival.

    Original languageEnglish (US)
    Pages (from-to)128-134
    Number of pages7
    JournalUrologic Oncology: Seminars and Original Investigations
    Volume32
    Issue number2
    DOIs
    StatePublished - Feb 1 2014

    Keywords

    • Compliance
    • Electronic medical records
    • Hematuria
    • Primary care physicians
    • Referral

    ASJC Scopus subject areas

    • Oncology
    • Urology

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