Presentation Authors: Natalia Leva*, San Francisco, CA, Kathryn Quanstrom, Ann Arbor, MI, Puneet Kamal, Hillary Copp, Lindsay Hampson, san francisco, CA
Introduction: In 2017, UCSF established a Transitional Urology (TU) clinic co-run by pediatric and adult urology aimed at providing comprehensive urologic care for pediatric patients with congenital urologic conditions transitioning into adulthood. We aimed to describe baseline demographic and disease characteristics of this population to better understand unmet needs of transitioning patients and identify barriers to access and utilization of care.
Methods: We performed a retrospective chart review of all new patients in the TU clinic at UCSF from February 2017 through August 2018. After approval from an institutional review board, demographics and clinical data were extracted from electronic medical records.
Results: 35 new patients were seen in UCSFâ€™s TU clinic during an 18-month period. Our cohort included 16 patients with spina bifida and neurogenic bladder, 6 with bladder or cloacal exstrophy, 4 with disorders of sexual development (DSD), 4 with obstructive uropathy and 1 patient each with calcinuria, imperforate anus, VACTERL, reflux nephropathy, and urachal cyst. Mean age of patients was 27.4 +8.0 years, 57% were male, 80% spoke English, and 63% had Medical or Medicare insurance. Patients lived an average of 97 +84 miles from the clinic and had a mean zipcode-based income of $60,738 +$25,800. There was an average of 11 months between the initial TU visit and the most recent prior urology visit, with a minimum of 11 days and maximum of 5 years. The mean time since last creatinine was 16 +17 months and since last renal ultrasound was 14 +21 months (excluding DSD patients). A total of 88 tests were ordered for 33 (94%) patients, and 63% of these were completed with 6 months. 18 (51%) patients warranted a total of 27 referrals to other providers, and 33% of these were obtained within 6 months.
Conclusions: According to our data, TU patients are likely to have public insurance, live far from the TU clinic, and come from low SES backgrounds. At initial presentation, over half of patients required updated tests like creatinine and renal ultrasound. Furthermore, half of patients required at least one referral to a different provider, suggesting that upon presenting to the TU clinic, these patients were not adequately â€œplugged in.â€ Our data indicate that access to subspecialty providers is a challenge. It is unclear whether this is due to insurance, inability to identify an appropriate adult subspecialty provider or access to care. Further investigation into barriers to implementation of transitional care is needed to provide comprehensive management to this challenging patient population.
Source of Funding: Dr. Hampson is supported by grant NIH/NIDDK K12K083021