Hematuria Evaluation in Primary Care Varies Widely

Less than half of primary care providers refer patients with any degree of hematuria for urological evaluation.
Less than half of primary care providers refer patients with any degree of hematuria for urological evaluation.

NEW ORLEANS—In a survey, primary care doctors and emergency medicine physicians reported a wide variety of practices for the diagnosis of hematuria, researchers revealed at the 2015 American Urological Association (AUA) annual meeting. Almost all respondents believed clinical care pathways would improve adherence to evidence-based guidelines.

For the study, investigators led by Lisa Parrillo, MD, of the Hospital of the University of Pennsylvania in Philadelphia, distributed a 22-question electronic survey to primary care providers in an academic health system. The survey gauged practice patterns in the evaluation and care coordination of gross and microscopic hematuria.  

Of the 135 providers who completed the survey, only 13% were aware of AUA guidelines on asymptomatic microscopic hematuria. Just 30% could define the symptom as 3 or more red blood cells per high-power field as viewed under a microscope based on a single urinalysis. An additional 51% defined it correctly based on the previous definition of 2 urinalyses with 3 red blood cells per high-power field.

For the work-up, the majority (65%) would not send a voided urine cytology; that means that 35% would, however. Slightly more than half (53%) would only image patients with additional indications, and 21% would not image patients at all.

When imaging was performed, a computed tomography urogram was used as often as a renal ultrasound. “Although upper tract tumors are relatively rare, especially in asymptomatic microscopic hematuria, an appropriate evaluation with contrast enhancement is necessary,” Dr. Parrillo explained.

Less than half (46%) of providers would appropriately recommend urology consultation for any hematuria, 38% for gross hematuria only, 10% for microscopic hematuria only, and 7% never.

Almost all survey participants (93%) felt that a clinical care pathway for the evaluation and management of hematuria would prove valuable in their practice.

“We confirmed that primary care providers are unaware of evidence-based guidelines for hematuria, which may explain the variability in care with respect to evaluation with cytology, imaging, and appropriate referral to urology,” Dr. Parrillo stated. “Future collaborative efforts focusing on education and clinical pathways in primary care may reduce potential variations in care.”
 

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