Objective

To evaluate the predictors of establishing care with a reproductive urologist (RU) among men with abnormal semen analyses (SAs) ordered by nonurologists and examine patient perceptions of abnormal SAs in the absence of RU consultation.

Design

Retrospective cohort study with cross-sectional survey.

Setting

Large, integrated academic healthcare system during 2002–2019.

Patient(s)

We identified adult men undergoing initial SAs with nonurologists who had abnormalities. Patients with index SAs during 2002–2018 were included for the analysis of RU consultation. Men tested in 2019 were recruited for cross-sectional survey.

Intervention(s)

Cross-sectional survey.

Main Outcome Measure(s)

RU consultation and accurate perception of abnormal SAs.

Result(s)

A total of 2,283 men had abnormal SAs ordered by nonurologists, among whom 20.5% underwent RU consultation. Mixed-effect logistic regression modeling identified oligospermia as the strongest predictor of RU care (odds ratio, 3.08; 95% confidence interval, 2.43–3.90) with a significant provider-level random intercept. We observed substantial provider-level heterogeneity among nonurologists with provider-specific rates of RU evaluation ranging from 3.7% to 35.8%.

We contacted 310 men who did not undergo RU consultation with a 27.2% survey response rate. Of respondents, 6.7% reported receiving an RU referral. Among men with abnormal SAs not evaluated by RU, 22.7% appropriately perceived an abnormal SA.

Conclusion(s)

In men with abnormal SAs diagnosed by nonurologists, the rate of RU consultation was low and associated with substantial provider-level variation among ordering providers. Patients without RU consultation reported inaccurate perceptions of their SA. Multidisciplinary efforts are needed to ensure that subfertile men receive appropriate RU evaluation.

中文翻译：

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不育男性的生殖泌尿科会诊：精液检测异常后建立护理和患者感知的预测因素

客观的

评估由非泌尿科医师安排的精液分析异常 (SAs) 男性中与生殖泌尿科医师 (RU) 建立护理的预测因素，并在没有 RU 咨询的情况下检查患者对异常 SAs 的看法。

设计

具有横断面调查的回顾性队列研究。

环境

2002-2019 年期间的大型综合学术医疗保健系统。

患者）

我们确定了接受初始 SA 的成年男性与有异常的非泌尿科医生。2002-2018 年期间具有指数 SA 的患者被纳入 RU 咨询分析。招募了 2019 年接受测试的男性进行横断面调查。

干预措施

横断面调查。

主要观察指标）

RU咨询和异常SA的准确感知。

结果）

共有 2,283 名男性患有非泌尿科医生开出的异常 SA，其中 20.5% 接受了 RU 会诊。混合效应逻辑回归模型将少精子症确定为 RU 护理的最强预测因子（优势比，3.08；95% 置信区间，2.43-3.90），具有显着的提供者级随机截距。我们观察到非泌尿科医师之间存在显着的提供者水平异质性，提供者特定的 RU 评估率从 3.7% 到 35.8% 不等。

我们联系了 310 名未接受 RU 咨询的男性，调查回复率为 27.2%。在受访者中，6.7% 的人表示收到了 RU 推荐。在未由 RU 评估的异常 SA 的男性中，22.7% 适当地感知到异常 SA。

结论

在由非泌尿科医生诊断出的异常 SA 的男性中，RU 咨询率很低，并且与订购提供者之间的提供者级别差异很大。没有 RU 咨询的患者报告了他们对 SA 的不准确看法。需要多学科的努力来确保不育男性接受适当的 RU 评估。