EAU 2017: Follow Up Care After Emergency Department Visits For Kidneys Stones –a Missed Opportunity

London, England (UroToday.com) With increasing incidence of urolithiasis, there is a parallel increase in the number of patients undergoing stone procedures. Emergency department (ED) visits are common in patients with kidney stones relocating and blocking the upper urinary tract flow and provoking an acute renal colic. Patience noncompliance with subsequent visits or procedures necessary to prevent secondary stone episodes is very common. Many factors play a role in this situation; Hollingsworth and colleagues presented a study on patient compliance for follow up prevention treatment and procedures.

Authors used Truven Health Analytics’ MarketScan Commercial Clams and Encounters Database to identify patients with an ED visit for kidney stones. Authors assessed whether a patient received outpatient services within 90 days of his/her primary ED visit. Additionally, they performed a multivariable logistic regression models to evaluate the association between receipt of post-ED follow-up care and ED revisit, as well as the initiation of secondary stone prevention.

A total of 70,294 patients with an ED visit for kidney stones were identified to fit the criteria to be included in the study. Of these, 48% had follow-up care within 90 days, over two-thirds of whom (68.3%) were seen by a urologist. While follow-up care receipt was not associated with lower ED revisit rates, as shown in the Figure below, patients had higher odds of performing a 24-hour urine collection [odds ratio (OR), 2.55; 95% confidence interval (CI), 2.23 to 2.92] and being prescribed preventive pharmacological therapy if they had an outpatient visit within 90 days of ED discharge. Odds of receiving secondary stone prevention were even higher when patients were seen by a urologist in follow-up.

As study confirms, it is well known that follow up and preventive procedures after initial stone presentation remains important to prevent subsequent renal colic events. We believe that improving patient communication and explaining them the importance of follow up procedures is crucial.

Dr. Ghani concluded that almost half of patients seen acutely in the emergency department for kidney stone acute renal attacks do not receive follow-up care. Given that this follow-up is associated with greater use of secondary stone prevention, efforts to enhance linkages across settings are needed in order to provide these patients more comprehensive care.

Speaker(s): Khurshid Ghani, MD

Authors: Hollingsworth J, Hollenbeck B.K., Ghani K.R.

at the #EAU17 - March 24-28, 2017- London, England