Back to 2024 Abstracts
KSP by Degree: A Comparison of Patient Satisfaction with Counseling for Kidney Stone Prevention by Physician versus Advanced Practice Provider
Erin Santos, PA, MPH, MS
1, Loren Smith, MD
2, Evelyn James, MPH
1, Jesse D. Sammon, DO
2, David Sobel, MD
2
1Maine Medical Partners Urology, South Portland, ME, USA, 2Maine Medical Center, Portland, ME, USA
Introduction and Objectives: There is limited data characterizing the reception and impact of advanced practice providers (APPs) in urologic care despite the support of the American Urologic Association (AUA). Current research in this arena demonstrates equivalent patient satisfaction when office care is delivered by an APP versus a surgeon. It remains unclear if this holds true across the entire spectrum of urologic diagnoses. The metabolic evaluation and management of kidney stone disease remains bread and butter endourology care suitable for APP evaluation. Through quality metrics we interrogated the question of patient satisfaction regarding metabolic kidney stone analysis and prevention as directed by an APP versus physician.
Methods: A retrospective assessment of patient satisfaction was surveyed before and after an encounter with one of 13 APPs or 11 surgeons at a single high-volume urology practice over 21 months. Patient satisfaction was assessed by the validated Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS). Responses were analyzed across specific diagnoses between provider category. Controlling for patient characteristics (age, race, gender, marital status) multivariate analysis was calculated to determine the independent effect of provider type and patient quality measures such as satisfaction with respect to metabolic kidney stone disease.
Results: 29,364 patient visits from January 2022 to September 2023 were investigated to include 204 patients meeting inclusion criteria including ICD diagnosis code. There were no statistically significant difference in demographics when seen by an APP versus a physician (Table 1). Further, the multivariable analyses, controlling for covariates, found no statistically significant differences in patient satisfaction when seen by an APP versus a physician. (Table 2).
Conclusions: Similar patient satisfaction was seen in both APP and physician visits for metabolic kidney stone prevention despite the subspecialty nature of urologic practice. Given the impending national shortage of urologic surgeons, APPs can and should be utilized for optimal patient outcomes and clinic flow to enhance the provision of high quality care. We plan further research to identify any barriers to utilization of APPs for kidney stone prevention.
Table 1: Demographics
| | | |
| Physician (N=69) | Advanced Practice Provider (N=135) | Total (N=204) |
| Sex | | | |
| Male | 17 (39.5%) | 44 (41.1%) | 61 (40.7%) |
| Female | 26 (60.5%) | 63 (58.9%) | 89 (59.3%) |
| Age Group | | | |
| Younger than 50 | 14 (20.3%) | 12 (8.9%) | 26 (12.7%) |
| 50 to 70 | 31 (44.9%) | 93 (68.9%) | 124 (60.8%) |
| 70 and older | 24 (34.8%) | 30 (22.2%) | 54 (26.5%) |
| Age | | | |
| Median [IQR] | 64.0 [19.0] | 65.0 [12.0] | 65.0 [14.0] |
| Race | | | |
| White | 68 (98.6%) | 131 (97.0%) | 199 (97.5%) |
| Black | 0 (0%) | 1 (0.7%) | 1 (0.5%) |
| Other | 1 (1.4%) | 3 (2.2%) | 4 (2.0%) |
| Marital Status | | | |
| Single | 18 (26.1%) | 23 (17.0%) | 41 (20.1%) |
| Married/Partner | 39 (56.5%) | 100 (74.1%) | 139 (68.1%) |
| Divorced/Separated/Widowed | 12 (17.4%) | 12 (8.9%) | 24 (11.8%) |
Table 2: Patient Satisfaction with APP vs Physician, Multivariable Analysis
| | | | |
| Characteristic | OR1 | 95% CI1 | p-value | |
| Provider | | | | |
| Physician | — | — | | |
| Advanced Practice Provider | 0.70 | 0.20, 2.16 | 0.5 | |
| Age Group | | | | |
| 50 to 70 | — | — | | |
| Younger than 50 | 0.39 | 0.12, 1.38 | 0.13 | |
| 70 and older | 6.23 | 1.15, 116 | 0.086 | |
| Sex | | | | |
| Male | — | — | | |
| Female | 0.63 | 0.21, 1.75 | 0.4 | |
| Marital Status | | | | |
| | | | |
| | | | |
| Single | — | — | | |
| Married/Partner | 0.74 | 0.18, 2.42 | 0.6 | |
| Divorced/Separated/Widowed | 0.40 | 0.07, 2.07 | 0.3 | |
| 1 OR = Odds Ratio, CI = Confidence Interval |
Back to 2024 Abstracts
