A Framework for Addressing Health Disparities in Adult Neurogenic Lower Urinary Tract Dysfunction-Systematic Review and Neurogenic Bladder Research Group Recommendations.

The systematic review and workshop recommendations by the Neurogenic Bladder Research Group offer a comprehensive framework for evaluating health disparities in adult neurogenic lower urinary tract dysfunction (NLUTD). The study acknowledges the multifaceted nature of health, highlighting that medical care, though critical, is not the sole determinant of health outcomes. Social determinants of health significantly influence the disparities seen in NLUTD. This report calls for a shift in focus from traditional urologic care to a broader, more inclusive perspective that accounts for the complex interplay of social, economic, and health care factors in managing NLUTD.

Long-Term Impact of Medicaid Expansion on Prostate Cancer Screening.

INTRODUCTION: Prostate cancer is the most common noncutaneous malignancy in men. The updated PSA testing 2018 United States Preventive Services Task Force guidelines recommend shared decision-making for men ages 55 to 69. In 2010, the Affordable Care Act expanded Medicaid coverage to childless adults earning < 138% of the federal poverty level. Thereafter, individual states have chosen to adopt or defer Medicaid expansion at different times. This allows for the opportunity to study the effects of expansion on a population that did not previously qualify for Medicaid. We examine the long-term association of Medicaid expansion on prostate cancer screening. METHODS: Data from the Behavioral Risk Factor Surveillance System were extracted for childless men earning less than 138% of the federal poverty level in states with different Medicaid expansion statuses from 2012 to 2020. States were classified into 4 expansion categories: very early expansion states, early expansion states, late expansion states, and nonexpansion states. Prevalence of PSA screening was determined for each category of expansion. Difference-in-difference analyses were used to understand variations in very early expansion states, early expansion states, and late expansion states trends with reference to nonexpansion states. RESULTS: PSA screening prevalence decreased in very early expansion states (27.76% vs 18.50%), early expansion states (33.79% vs 18.09%), late expansion states (36.08% vs 19.14%), and nonexpansion states (38.82% vs 24.40%) from 2012 to 2020. However, the difference-in-difference analyses did not show statistically significant results among any of the years and expansion category groups in our study period. CONCLUSIONS: PSA screening prevalence decreased in all states, regardless of expansion category. No long-term effect of Medicaid expansion on PSA screening prevalence was observed among states with different expansion statuses.

eConsult Provides a Novel Opportunity to Evaluate Hematuria Referrals for Medicaid Patients in the "Real-World" Community.

INTRODUCTION: We utilized an eConsult program to assess the appropriateness and completeness of hematuria evaluation among one of the largest Medicaid networks in California, the Inland Empire Health Plan. METHODS: We retrospectively reviewed all hematuria consults from May 2018 to August 2020. Patient demographic and clinical data were extracted from the electronic health record and dialogues between primary care provider and specialist including laboratory results and imaging. We calculated the proportions of imaging types and the outcome of the eConsults among patients. χ2 and Fisher's exact tests were used for statistical analysis. RESULTS: A total of 106 hematuria eConsults were submitted. Primary care provider evaluation for risk factors rates were low: 37% gross hematuria, 29% voiding symptoms/dysuria, 49% other urothelial risk factors or benign etiology, and 63% smoking. Only 50% of all referrals were deemed appropriate based on a history of gross hematuria or ≥3 red blood cells/high-power field on urinalysis without evidence of infection or contamination. Thirty-one percent of patients received a renal ultrasound, 2.8% received CT urography, 5.7% received other cross-sectional imaging, and 64% received no imaging. By the conclusion of the eConsult only 54% of patients were referred for a face-to-face visit. CONCLUSIONS: The use of eConsults allows for urological access in the safety-net population and presents a means to assess the urological needs in the community. Our findings suggest eConsults represent an opportunity to reduce the morbidity and mortality associated with hematuria among safety-net patients who are otherwise less likely to receive a proper evaluation.

Long-Term Impact of Medicaid Expansion on Colorectal Cancer Screening in Its Targeted Population.

INTRODUCTION: Colorectal cancer screening continuously decreased its mortality and incidence. In 2010, the Affordable Care Act extended Medicaid eligibility to low-income and childless adults. Some states elected to adopt Medicaid at different times while others chose not to. Past studies on the effects of Medicaid expansion on colorectal cancer screening showed equivocal results based on short-term data following expansion. AIMS: To examine the long-term impact of Medicaid expansion on colorectal cancer screening among its targeted population at its decade mark. METHODS: Behavioral Risk Factor Surveillance System data were extracted for childless adults below 138% federal poverty level in states with different Medicaid expansion statuses from 2012 to 2020. States were stratified into very early expansion states, early expansion states, late expansion states, and non-expansion states. Colorectal cancer screening prevalence was determined for eligible respondents. Difference-in-differences analyses were used to examine the effect of Medicaid expansion on colorectal cancer screening in states with different expansion statuses. RESULTS: Colorectal cancer screening prevalence in very early, early, late, and non-expansion states all increased during the study period (40.45% vs. 48.14%, 47.52% vs 61.06%, 46.06% vs 58.92%, and 43.44% vs 56.70%). Difference-in-differences analysis showed significantly increased CRC screening prevalence in very early expansion states during 2016 compared to non-expansion states (Crude difference-in-differences + 16.45%, p = 0.02, Adjusted difference-in-differences + 15.9%, p = 0.03). No statistical significance was observed among other years and groups. CONCLUSIONS: Colorectal cancer screening increased between 2012 and 2020 in all states regardless of expansion status. However, Medicaid expansion is not associated with long-term increased colorectal cancer screening prevalence.

Kidney Stone Surgery: Assessing Public Interest and Evaluating Social Media Content.

An increasing number of patients are utilizing the internet to answer their medical questions. Given the lack of verified stone treatment resources on the web, we sought to evaluate online interest in kidney stone surgical interventions and assess the quality of the most popular resources on social media. Google Trends was used to evaluate public interest in different kidney stone interventions between March 2016 and February 2021 and reported as search volume index (SVI). Next, the social media analysis tool, BuzzSumo, was used to identify stone surgery content online on the social media platforms, YouTube, Instagram, Pinterest, Reddit, and Twitter. To evaluate the quality of health information presented in the online resources, the DISCERN instrument was employed by three individual raters. Ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), and extracorporeal shockwave lithotripsy (SWL) were identified as the top search terms on Google Trends with mean SVIs of 47.75, 42.98, and 45.74, respectively (p = 0.012). On YouTube, URS, PCNL, and SWL had 12,549, 116,222, and 20,717 views, respectively. Nine articles and fifteen videos were chosen for analysis using the DISCERN tool with a mean score of 2.82 and 2.27, respectively, among three independent evaluators. The result of our study suggests that online users are interested in URS but engaged more often with PCNL content on social media platforms. We found that the quality of online resources related to stone surgery highlights the need for involvement of urologists in creation of engaging high-quality content and sharing of accurate information in a social media-driven society.

Online Engagement with Surgical Treatments for Benign Prostatic Hyperplasia: Are Minimally Invasive Surgical Therapies Outpacing the Gold Standard?

Background: Patients suffering from progressive symptoms of benign prostatic hyperplasia (BPH) increasingly turn to the internet for information on invasive and minimally invasive surgical therapies (MIST). This study aimed to identify online articles accessed by patients seeking guidance on said options and to evaluate the quality and readability of their content. Methods: Social media analytics tool Buzzumo was used to identify the most shared articles on Facebook, Twitter, Reddit, and Pinterest related to BPH surgical treatments from 2016 to 2021. The content quality was graded using the DISCERN tool; a questionnaire that assesses the quality of written information on treatment choices for a health problem. An online Automatic Readability Checker was used to evaluate the readability of the written transcripts. Google Trends data were used to evaluate search term popularity for BPH procedures from 2016 to 2021. Google Trends data and DISCERN ratings were analyzed with ANOVA and paired t-test, respectively. Results: Thirty-nine percent of identified articles were rated as low quality, 39% as moderate quality, and 22% as high quality using the DISCERN tool, with no significant difference among reviewer ratings (p = 0.0561). The median reading level of all articles was 12th grade. Google Trends data illustrated a rising popularity of MIST such as Rezum and urethral lift (Urolift), exceeding interest in more invasive procedures such as Holmium laser enucleation of the prostate (HoLEP) and laser surgery. Transurethral resection of the prostate (TURP) remained popular with no significant difference between MIST and TURP on Google Trends (p = 3.46). Conclusions: The most accessed articles on BPH treatments have important shortcomings, including risks of treatment and other available options for treatment. Article transcripts exceed the reading level of the average adult patient. TURP has remained a popular procedure online, but there is a notable rising interest in MIST, especially Urolift.