A decision aid for GPs for the treatment of elderly male patients with lower urinary tract symptoms (LUTS)

Autor: J. André Knottnerus, Piet J. M. Portegijs, Kees van de Beek, Onno C. P. van Schayck, Roelf J. C. Norg
Rok vydání: 2006
Předmět:
Male
Urologic Diseases
medicine.medical_specialty
Cholestenone 5 alpha-Reductase
Urologic Surgical Procedures
Male
Referral
medicine.medical_treatment
Population
Urology
Physical examination
Sensitivity and Specificity
Severity of Illness Index
Decision Support Techniques
Cohort Studies
Quality of life
Lower urinary tract symptoms
Internal medicine
Surveys and Questionnaires
medicine
Humans
Practice Patterns
Physicians'
education
Referral and Consultation
Adrenergic alpha-Antagonists
Aged
education.field_of_study
medicine.diagnostic_test
business.industry
Physicians
Family
Middle Aged
Prostate-Specific Antigen
medicine.disease
Cross-Sectional Studies
Logistic Models
Treatment Outcome
Research Design
Creatinine
Population Surveillance
Quality of Life
International Prostate Symptom Score
Prostate surgery
business
Family Practice
Watchful waiting
Biomarkers
Zdroj: Family practice. 23(6)
ISSN: 0263-2136
Popis: GPs have four main treatment options for lower urinary tract symptoms (LUTS): watchful waiting, alpha-blockers, 5-alpha-reductase inhibitors or (referral for) surgery. Guidelines do not provide clear cut-off values for (combinations of) symptoms and physical examination results to decide which treatment is best.(i) To develop a decision aid ('checklist') for GPs for the treatment of patients with LUTS. (ii) To assess its value for use in a primary care population. Materials and methods. Population-based cross-sectional study. Included were subjects with uncomplicated LUTS for whom treatment in primary care may be appropriate. [International Prostate Symptom Score (IPSS)or = 8, no prior prostate surgery, prostate-specific antigen (PSA) value10 ng/ml]. For each subject the appropriateness of surgery and alpha-blocker treatment was determined using a previously validated formalized international expert panel judgement. Regression models using data available in primary care were constructed to predict the panel judgement. Subsequently these models were transformed into simple checklists. Finally, the efficiency of these checklists was calculated.The best checklists consisted of age, symptoms severity, type of symptoms, a quality of life score and PSA value. Assuming one would like to provide at least 95% of the subjects for whom a certain treatment is appropriate with this treatment (i.e. 'sensitivity' of the checklistor = 95%), one can reach a positive predictive value of 50-60%.Simple checklists based on the judgement of experts regarding the most appropriate therapy can help GPs to advise their patients of a rational treatment strategy.
Databáze: OpenAIRE
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