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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 廖俊厚 | 泌尿科醫師及家庭醫師對於前列腺肥大病患的評估及治療方式的異同: 從前列腺肥大登錄系統 (BPH registry)獲得的資料 | 2012/11/27 上午 09:47:54 | 0 |
| 原 文 | 題 目 | Benign prostatic hyperplasia evaluation and management by urologists and primary care physicians: practice patterns from the observational BPH registry. |
| 作 者 | Wei JT, Miner MM, Steers WD, Rosen RC, Seftel AD, Pasta DJ, Carman WJ, Roehrborn CG; BPH Registry Steering Committee | |
| 出 處 | J Urol. 2011 Sep;186(3):971-6. | |
| 出版日期 | 2011 July | |
| 評 論 |
本研究的目的是透過前列腺肥大登錄系統 (BPH registry)獲得的資料來評估泌尿科醫師及家庭醫師(primary care physicians)對於前列腺肥大/下泌尿道症狀(LUTS)的評估及治療方式的異同。 前列腺肥大登錄及病人普查系統 (BPH registry and Patient Survey)是美國從2004年1月到2005年2月縱貫性(longitudinal)及觀察性(observational)的疾病登錄樣本研究。這個樣本研究評估了醫師對前列腺肥大及下泌尿道症狀的治療方式，以及病人的治療效果。共蒐集了402位泌尿科及家庭醫師，以及6924位前列腺肥大/下泌尿道症狀病人接受藥物治療或觀察的資料。 經過多變數分析(multivariate analysis)發現泌尿科醫師較家庭醫師有3.9倍的機會執行尿液檢驗(urinalysis)，有1.2倍的機會檢測血清前列腺特異抗原(serum prostate specific antigen)，有18.9倍的機會測解尿後膀胱殘餘尿量(post-void residual urine)，17.3倍的機會進行尿流速檢測(uroflowmetry)，7.7倍的機會進行前列腺超音波(prostate ultrasound)，3.5倍的機會施行前列腺切片(biopsy)，4.0倍的機會施行腎臟超音波(renal ultrasound)，4.6倍的機會施行膀胱鏡檢查(cystoscopy)。但泌尿科醫師較家庭醫師較少執行腎功能檢測(measure creatinine)，約只有0.1倍的機會。 病人因前列腺肥大就診泌尿科醫師而接受藥物治療而非觀察的機會是就診家庭醫師的兩倍，不同專科對前列腺肥大的藥物治療也有不同。 由本研究可以發現美國泌尿科醫師及家庭醫師(primary care physicians)對於前列腺肥大/下泌尿道症狀(LUTS)的評估及治療方式的不同。這些資料可以當作一些指標並提供改進前列腺肥大病患照護的一些參考，而台灣目前似乎還未有這樣的前列腺肥大登錄系統，或許這是未來我們可以考慮進行的方向。 |
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| abstract |
PURPOSE: We examined the evaluation of and management for lower urinary tract symptoms/benign prostatic hyperplasia by physician specialty (urologist vs primary care physician). MATERIALS AND METHODS: The BPH Registry and Patient Survey is a longitudinal, observational, disease registry cohort of patients enrolled from January 2004 to February 2005 in the United States. The survey examines patient outcomes and physician practice patterns in the management of lower urinary tract symptoms associated with clinical benign prostatic hyperplasia. It includes 402 urologist and primary care physician practices throughout the United States. Included in this study were 6,924 men with lower urinary tract symptoms/benign prostatic hyperplasia managed by watchful waiting or medical therapy. Data were collected on demographics, clinical characteristics and lower urinary tract symptoms/benign prostatic hyperplasia management using physician and patient completed forms. Multivariate analysis was done by physician specialty. RESULTS: Based on multivariate analysis urologists were more likely than primary care physicians to perform urinalysis (OR 3.9), serum prostate specific antigen (OR 1.2) and post-void residual urine (OR 18.9) measurement, uroflowmetry (OR 17.3), prostate ultrasound (OR 7.7) and biopsy (OR 3.5), renal ultrasound (OR 4.0) and cystoscopy (OR 4.6) but less likely to measure creatinine (OR 0.1). Men seeing urologists were twice as likely as men seeing primary care physicians to be treated with benign prostatic hyperplasia medical therapy vs watchful waiting. Significant differences by physician specialty were also observed for specific benign prostatic hyperplasia medical therapies. CONCLUSIONS: Significant differences in practice patterns were observed between primary care physicians and urologists in the evaluation of and management for lower urinary tract symptoms/benign prostatic hyperplasia. These data establish valuable benchmarks and identify possible interventions that may improve the standard of care. |
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