A new model for delivering care for lower urinary tract symptoms

Abstract

Introduction: Lower urinary tract symptoms (LUTS) are being treated in secondary care settings, resulting in delayed access for all patients. The objectives of this study were to examine the effects of an integrated delivery model on 1) the volume of care delivered in the secondary care setting; and 2) the use of potentially unnecessary care associated with LUTS. Methods: This study was based on a retrospective analysis of administrative data collected before and after the integrated LUTS clinic was introduced in Calgary, Alberta. Two cohorts of patients diagnosed with one of four conditions associated with LUTS were defined: 1) the year prior to the introduction of the integrated LUTS clinic; and 2) the year after. To measure their utilization of care, patients' healthcare records between the clinic, emergency department, and hospital were linked. The integrated LUTS clinic involved a multidisciplinary care team, co-located with a common electronic medical record system using a pre-established clinical pathway. Results: After the introduction of the integrated LUTS clinic, there was a significant increase in the proportional number of patients receiving followup care at the clinic and a significant decrease in the proportional number of patients receiving a cystoscopy or being admitted to the hospital. There was no change in the number of patients visiting the emergency department. Conclusions: An integrated delivery model can be successfully implemented in secondary care for delivering chronic care. The integrated LUTS clinic improved access to care for patients and reduced their use of unnecessary services.