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Referral patterns to urogynecologists
Referral Patterns to Urogynecologists Mark L. Mokrzycki, MD UMDNJ–Robert Wood Johnson Medical School/Saint Peter’s University Hospital, New Brunswick, NJ
Michael N. Maurice, MD PURPOSE: To determine referral patterns of general obstetrician– gynecologists to fellowship-trained urogynecologists. METHODS: A four-part questionnaire was mailed to 1,000 physicians. Twenty physicians from each state were randomly selected using health care plan directories. Part 1 screened respondents for active practice and access to a urogynecologist. Part 2 ascertained years in practice and job setting. Part 3 determined whether breadth of a urogynecologist’s practice or derivation of salary would affect referral patterns. Part 4 asked respondents how often they would refer to a urogynecologist based on 14 procedures and 11 pelvic floor conditions. RESULTS: There were 223 responses, for a response rate of 22.3%. Fourteen responses were excluded from analysis for negative answers to the screening questions, leaving 209 (20.9%) for final analysis. Respondents averaged 9.1 years in practice and worked mostly in groups (60.3%), followed by university hospital based (21.1%), solo practice (14.3%), and community hospital based (4.3%). Table 1 displays the results Urogynecology practice
More likely
Less likely
No difference
Urogynecology General gynecology Obstetrics Salary derivation University salaried Community hospital salaried Private practice
112 37 11
10 23 122
87 149 76
53 8
14 42
142 159
22
40
147
Procedure Vaginal hysterectomy Abdominal hysterectomy Anterior colporrhaphy Posterior colporrhaphy Sacrocolpopexy Sacrospinous ligament fixation Burch procedure Pubovaginal sling Cystoscopy Paravaginal repair Colpocleisis Fistula repair Urodynamic testing Pessary fitting
Always
Frequently
Always
Frequently
Infrequently
Never
33
91
57
28
108
88
8
5
44 31
40 97
79 57
46 24
112
84
6
7
18 29 41 47 31 33
67 84 106 104 52 35
87 62 50 46 96 69
37 34 12 12 30 72
of part 3 of the questionnaire, whereas tables 2 and 3 pertain to part 4. CONCLUSION: Generalists are more likely to refer if a urogynecologist practices urogynecology solely. Generalists tend to refer for procedures such as urodynamic testing, cystoscopy, complicated prolapse surgery, and antiincontinence surgery, and for conditions such as urinary incontinence and pelvic organ prolapse.
Safety Update: Medication for Overactive Bladder in Women Peter K. Sand, MD Northwestern University Medical School, Evanston, IL
Infrequently
Never
4 2
7 6
101 82
97 119
5
19
116
69
5
21
117
66
130 140
49 42
13 15
17 12
118 153 32 73 134 110 155 3
42 30 88 101 48 45 36 25
28 15 57 19 16 30 8 89
21 11 32 16 11 24 10 92
VOL. 99, NO. 4 (SUPPLEMENT), APRIL 2002
Condition Primary urinary incontinence Recurrent urinary incontinence Fecal incontinence Primary pelvic organ prolapse Recurrent pelvic organ prolapse Cystocele Rectocele Uterine prolapse Vaginal vault prolapse Enterocele Rectal prolapse
OBJECTIVE: Oxybutynin, a pregnancy class B drug with antimuscarinic and musculotropic activity, has been available for more than 30 years. Tolterodine, a pregnancy class C drug with antimuscarinic activity, has been available for 4 years. The authors examined the incidence of adverse events with 10 mg extended-release oxybutynin chloride (Ditropan XL) once daily and 4 mg immediate-release tolterodine tartrate (Detrol), 2 mg twice daily, in women younger than 65 years during a randomized double-blind study. METHODS: Women (n ⫽ 202; range 21– 64 years) with urge incontinence and urinary frequency were randomized to a daily dose of 10 mg Ditropan XL once daily or 4 mg Detrol, 2 mg twice daily, for 12 weeks. Safety and efficacy data were collected in 7-day, 24-hour daily urinary diaries and during office visits. RESULTS: Adverse effects, which occurred in at least 3% of patients, are shown in the table. The incidence of most adverse
WEDNESDAY POSTERS
109S
Michael N. Maurice, MD PURPOSE: To determine referral patterns of general obstetrician– gynecologists to fellowship-trained urogynecologists. METHODS: A four-part questionnaire was mailed to 1,000 physicians. Twenty physicians from each state were randomly selected using health care plan directories. Part 1 screened respondents for active practice and access to a urogynecologist. Part 2 ascertained years in practice and job setting. Part 3 determined whether breadth of a urogynecologist’s practice or derivation of salary would affect referral patterns. Part 4 asked respondents how often they would refer to a urogynecologist based on 14 procedures and 11 pelvic floor conditions. RESULTS: There were 223 responses, for a response rate of 22.3%. Fourteen responses were excluded from analysis for negative answers to the screening questions, leaving 209 (20.9%) for final analysis. Respondents averaged 9.1 years in practice and worked mostly in groups (60.3%), followed by university hospital based (21.1%), solo practice (14.3%), and community hospital based (4.3%). Table 1 displays the results Urogynecology practice
More likely
Less likely
No difference
Urogynecology General gynecology Obstetrics Salary derivation University salaried Community hospital salaried Private practice
112 37 11
10 23 122
87 149 76
53 8
14 42
142 159
22
40
147
Procedure Vaginal hysterectomy Abdominal hysterectomy Anterior colporrhaphy Posterior colporrhaphy Sacrocolpopexy Sacrospinous ligament fixation Burch procedure Pubovaginal sling Cystoscopy Paravaginal repair Colpocleisis Fistula repair Urodynamic testing Pessary fitting
Always
Frequently
Always
Frequently
Infrequently
Never
33
91
57
28
108
88
8
5
44 31
40 97
79 57
46 24
112
84
6
7
18 29 41 47 31 33
67 84 106 104 52 35
87 62 50 46 96 69
37 34 12 12 30 72
of part 3 of the questionnaire, whereas tables 2 and 3 pertain to part 4. CONCLUSION: Generalists are more likely to refer if a urogynecologist practices urogynecology solely. Generalists tend to refer for procedures such as urodynamic testing, cystoscopy, complicated prolapse surgery, and antiincontinence surgery, and for conditions such as urinary incontinence and pelvic organ prolapse.
Safety Update: Medication for Overactive Bladder in Women Peter K. Sand, MD Northwestern University Medical School, Evanston, IL
Infrequently
Never
4 2
7 6
101 82
97 119
5
19
116
69
5
21
117
66
130 140
49 42
13 15
17 12
118 153 32 73 134 110 155 3
42 30 88 101 48 45 36 25
28 15 57 19 16 30 8 89
21 11 32 16 11 24 10 92
VOL. 99, NO. 4 (SUPPLEMENT), APRIL 2002
Condition Primary urinary incontinence Recurrent urinary incontinence Fecal incontinence Primary pelvic organ prolapse Recurrent pelvic organ prolapse Cystocele Rectocele Uterine prolapse Vaginal vault prolapse Enterocele Rectal prolapse
OBJECTIVE: Oxybutynin, a pregnancy class B drug with antimuscarinic and musculotropic activity, has been available for more than 30 years. Tolterodine, a pregnancy class C drug with antimuscarinic activity, has been available for 4 years. The authors examined the incidence of adverse events with 10 mg extended-release oxybutynin chloride (Ditropan XL) once daily and 4 mg immediate-release tolterodine tartrate (Detrol), 2 mg twice daily, in women younger than 65 years during a randomized double-blind study. METHODS: Women (n ⫽ 202; range 21– 64 years) with urge incontinence and urinary frequency were randomized to a daily dose of 10 mg Ditropan XL once daily or 4 mg Detrol, 2 mg twice daily, for 12 weeks. Safety and efficacy data were collected in 7-day, 24-hour daily urinary diaries and during office visits. RESULTS: Adverse effects, which occurred in at least 3% of patients, are shown in the table. The incidence of most adverse
WEDNESDAY POSTERS
109S