Optimizing New Urogynecology Consultations: Advanced Practice Providers as Key

Objectives: Advanced practice providers (APPs) are ubiquitous in urogynecology, but we lack studies that evaluate their integration into outpatient care. This study evaluated a new outpatient care model wherein APPs functioned as new patient consultants. For the present study, we sought to determine the concordance (agreement) of a recommended care plan for operative intervention between the APP at an initial consultation and the surgeon at a subsequent consultation. We hypothesized that this model would yield high (> 90%) concordance.

Methods: This was a prospective feasibility study of women > 18 years seeking new consultations for stress urinary incontinence, urge urinary incontinence or overactive bladder, mixed urinary incontinence, prolapse, and mesh complications. As our present study sought to evaluate operative intervention concordance, patients electing non-operative management were excluded. A confidence interval approach was used to calculate an a priori sample size of 100 women. A one-sided upper 95% confidence interval (CI) was used to estimate concordance. Concordance was measured as the percentage of the sample when there was agreement in the recommended care plan for operative intervention by the APP and surgeon. Secondary outcomes included concordance between the APP and surgeon for the specific operative procedure when applicable, reasons for non-concordance for the recommended care plan, patient wait times to initial consultation, and patient satisfaction. Patient satisfaction was evaluated using the Consultation Satisfaction Questionnaire (CSQ) and stratified by APP.

Results: Of 517 new consultations, 166 (32%) women met inclusion criteria and were followed longitudinally until a sample of 100 completed their subsequent consultation with the surgeon. In our sample of 100 women, we found a 95% concordance (one-sided 95% CI: 0.90-1.00) for a recommended care plan of operative intervention between the APP and surgeon. Of the 30 operative plans specified, 29 (97%, one-sided 95% CI: 0.85-1.00) were concordant. Concordance and reasons for non-concordance are shown in Table 1. The median time to initial consultation was 49 days (IQR 40 to 77 days). Eighty-one percent of women completed the CSQ. Regardless of satisfaction domain, participants were highly satisfied with the initial APP consultation as shown by median CSQ scores in Figure 1 with a maximum score of 5. Specifically, 80 participants (99%) agreed or strongly agreed with the statement “I am totally satisfied with my visit to this provider.”

Conclusions: In women undergoing a new patient consultation for urogynecology, a high concordance of 95% between the APP and surgeon for operative intervention suggests that this new model was efficacious. Furthermore, when APPs completed the initial patient consultation, patients reported that they were highly satisfied with their care. This practice model that allowed APPs to function as new patient consultants provides a guide for future development and implementation of models that address our growing need for urogynecologists.