Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Jun 28, 2019; 9(2): 26-31
Published online Jun 28, 2019. doi: 10.5662/wjm.v9.i2.26
Treatment patterns of primary care physicians vs specialists prior to subspecialty urogynaecology referral for women suffering from pelvic floor disorders
Abigail Prentice, Ali Ahmad Bazzi, Muhammad Faisal Aslam
Abigail Prentice, Muhammad Faisal Aslam, Department of Family Medicine, Marquette Health System, Marquette, MI 49855, United States
Ali Ahmad Bazzi, Department of Obstetrics and Gynaecology, St. John Hospital and Medical Center, MI 48236, United States
Author contributions: Prentice A contributed to design of study, collecting data, creating the tables, and writing the manuscript; Bazzi AA contributed to calculating the statistics, creating the tables, writing the manuscript, submission and revisions; Aslam MF contributed to design of the study, data interpretation, writing the manuscript and revisions.
Institutional review board statement: The St. John Hospital and Medical Center IRB has APPROVED your submission. This approval is based on an appropriate risk/benefit ratio and a study design wherein the risks have been minimized. All research must be conducted in accordance with this approved submission.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data. Please refer to the IRB document which states informed consent and HIPPA waver documents were received.
Conflict-of-interest statement: None.
STROBE statement: The guidelines of the STROBE Statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ali Ahmad Bazzi, BSc, MD, Doctor, Department of Obstetrics and Gynaecology, St. John Hospital and Medical Center, 22201 Morross Road, Detroit, MI 48236, United States. ali.bazzi3@ascension.org
Telephone: +1-313-5229762
Received: January 29, 2019
Peer-review started: January 29, 2019
First decision: March 15, 2019
Revised: March 29, 2019
Accepted: April 8, 2019
Article in press: April 8, 2019
Published online: June 28, 2019
Abstract
BACKGROUND

There are approximately 25% of women in the United States suffering from pelvic floor disorders (PFDs) and this number is predicted to rise. The potential complications and increasing healthcare costs that exist with an operation indicate the importance of conservative treatment options prior to attempting surgery. Considering the prevalence of PFDs, it is important for primary care physician and specialists (obstetricians and gynecologists) to be familiar with the initial work-up and the available conservative treatment options prior to subspecialist (urogynecologist) referral.

AIM

To assess the types of treatments that specialists attempted prior to subspecialty referral and determine the differences in referral patterns.

METHODS

This is a retrospective cohort study of 234 patients from a community teaching hospital referred to a single female pelvic medicine and reconstructive surgery (FPMRS) provider for PFD. Specialist vs primary care provider (PCP) referrals were compared. Number, length and treatment types were studied using descriptive statistics.

RESULTS

There were 184 referrals (78.6%) by specialists and 50 (21.4%) by PCP. Treatment (with Kegel exercises, pessary placements, and anticholinergic medications) was attempted on 51% (n = 26) of the PCP compared to 48% (n = 88) of the specialist referrals prior to FPMRS referral (P = 0.6). There was no significant difference in length of treatment prior to referral for PCPs vs specialists (14 mo vs 16 mo, respectively, P = 0.88). However, there was a significant difference in the patient’s average time with the condition prior to referral (35 mo vs 58 mo for PCP compared to specialist referrals) (P = 0.02).

CONCLUSION

One half of the patients referred to FPMRS clinic received treatment prior to referral. Thus, specialists and generalists can benefit from education regarding therapies for PFD before subspecialty referral.

Keywords: Pelvic floor disorders, Referral patterns, Female pelvic medicine and reconstructive surgery, Primary care provider

Core tip: The true value of this study highlights the finding that half of the patients sent for subspecialist (urogynecologic) evaluation did not receive any treatment from primary care physicians and specialists (obstetricians and gynecologists) prior to the referral. This suggests that there is a potential paucity of knowledge about non-invasive therapy options available for pelvic floor disorders. This leaves room for education about these disorders, whether during residency training or through certification examinations. This could result in decreased healthcare costs and morbidities associated with surgical procedures.