Introduction and objective: Follow-up care after an ED visit for kidney stones may help reduce ED revisits and increase use of stone prevention strategies. To test these hypotheses, we analyzed medical claims from working-age adults with kidney stones.
Methods: Using data from MarketScan (2003 to 2006), we first identified patients with an ED visit for kidney stones. We then determined which patients had an outpatient visit within 90 days of ED discharge. Finally, we used multivariable logistic regression to evaluate the association between receipt of follow-up care and ED revisit, as well as use of stone prevention strategies (24-hour urine testing and PPT prescription).
Results: Only 48.0% (n=33,741) of patients seen in the ED for kidney stones received follow-up care, 68.3% of which was with a urologist. While follow-up care was not associated with fewer ED revisits, patients who received it were more likely to undergo 24-hour urine testing (predicted probability, 2.2% vs. 0.9%; P<0.001) and be prescribed PPT (predicted probability, 10.6% vs. 8.9%; P<0.001), when compared to those who did not. Among patients who received follow-up care, use of stone prevention strategies was higher when the care was delivered by a urologist (predicted probability, 13.7% vs. 12.3%; P=0.001).
Conclusions: Over half of patients seen acutely in the ED for kidney stones do not receive follow-up care. Given that follow-up care is associated with greater use of stone prevention strategies, efforts to enhance linkages across healthcare settings are needed to provide patients with urinary stone disease higher quality care.
Keywords: emergency service; preventative therapy; renal stone.