Mp45-05 Physician and Patient Adherence to Kidney Stone Prevention Guidelines in a Diverse, Low-Resource, Urban Population

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II (MP45)1 May 2024MP45-05 PHYSICIAN AND PATIENT ADHERENCE TO KIDNEY STONE PREVENTION GUIDELINES IN A DIVERSE, LOW-RESOURCE, URBAN POPULATION Emily R. Hunt, Tyler Bergeron, Kara L. Watts, Alexander C. Small, and Dima Raskolnikov Emily R. HuntEmily R. Hunt , Tyler BergeronTyler Bergeron , Kara L. WattsKara L. Watts , Alexander C. SmallAlexander C. Small , and Dima RaskolnikovDima Raskolnikov View All Author Informationhttps://doi.org/10.1097/01.JU.0001008764.86460.8e.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Guidelines from the American Urological Association (AUA) recommend that interested and high-risk stone formers undergo metabolic evaluation. Prior studies showed that patients with low socioeconomic status are less likely to complete 24-hour urine studies. We sought to assess specific barriers to implementing guideline-concordant kidney stone care among patients in a diverse, low-income, urban population. METHODS: We retrospectively reviewed the records of patients with recurrent kidney stones who underwent kidney stone surgery and completed a validated Social Determinants of Health (SDH) survey between 2016-2022. Clinical notes, orders, and pharmacy and laboratory records were reviewed during the year before and after kidney stone surgery. Compliance with AUA Guidelines was assessed with respect to each of: recommendation for and completion of 24-hour urine, results discussion, prescription for preventive medications, compliance with dietary/pharmacologic intervention, and repeat 24-hour urine recommendation and completion. RESULTS: 280 patients met inclusion criteria, of whom 25.4% were Black and 51.8% were Hispanic/Latino. Median age was 57 years (IQR 48-65). Of those eligible for metabolic evaluation based on AUA Guidelines, 123 (43.9%) were recommended to undergo 24-hour urine testing, 70 (25%) completed the collection, 51 (18.2%) had a visit to discuss results, 25 (8.9%) were recommended to repeat 24-hour urine after dietary or medical intervention counseling, 13 (4.6%) completed this repeat collection, and 10 (3.6%) had a visit to discuss repeat results. On univariate analysis, White or Asian race, increased and decreased BMI, multiple stones on imaging, and private insurance were associated with increased likelihood of guideline concordant care (p<0.05). CONCLUSIONS: Urban, low resource patients at high risk for kidney stone disease face substantial barriers to guideline concordant care. Further research is necessary to understand these specific barriers and create targeted interventions that may help to reduce disparities. Source of Funding: Albert Einstein College of Medicine - Medical Student Summer Research Fellowship © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e743 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Emily R. Hunt More articles by this author Tyler Bergeron More articles by this author Kara L. Watts More articles by this author Alexander C. Small More articles by this author Dima Raskolnikov More articles by this author Expand All Advertisement PDF downloadLoading ...