How does a physician know that his or her patients are in compliance and responding to the treatment plan as well as they should be?
Were a patient to pass a kidney stone and then get no additional treatment nor adjust diet and fluid intake, he or she would have a 50 percent chance of forming another stone within the next two years.
Yet, once we have identified the type of stone a patient is prone to forming, we have the ability to help them significantly reduce that risk. We advise our patients that drinking sufficient water and other fluids—enough to produce about 2 quarts of urine daily—will impede formation of all types of stones. We tell them that consuming foods with high levels of oxalate increases the risk of forming calcium oxalate stones; that too much animal protein in the diet increases the risk of uric acid stones; that a diet high in salt increase the risk of forming calcium containing kidney stones.
“You can tell a patient to take a medication, or follow a particular diet,” says Dr. Evan Goldfischer, “but the question remains… do they go out and do it? The process is very patient dependant and some doctors seem to be more persuasive than others.”
Litholink, a laboratory dedicated to measuring a patient’s urine for risk factors for stone disease, has provided a solution to the physician’s constant question: “Am I doing enough.”
The Litholink process begins with a metabolic analysis done several weeks after the patient’s bout with kidney stones. Using a special kit, the patient collects his or her urine for 24 to 48 hours and we send it on to Litholink. The company provides us an analysis of the factors—over thirty different measurements—putting the patient at high risk of stones. Using that information we are able to counsel our patients effectively.
LithoLink developed a structure that goes beyond metabolic analysis to also provide physicians with a way to measure outcomes of their treatment. Let’s say Premier Medical Group does metabolic analyses on a thousand patients and then makes treatment recommendations to these patients based on the analyses. Six months into treatment, we send LithoLink another urine sample from the patients for follow-up analysis. Litholink compares the new analyses to the original and is able to determine how many patients have improved in the various categories.
The results of our practice, and of thousands of others around the country, are put into a central database. This allows Litholink to provide us with a comparison of our outcomes in relation to that of everyone else in the network. It’s kind of a pulse. Doctors always wonder how they’re doing as compared to their colleagues, and with the Litholink quarterly reports, you actually find out how you rank.
What is most important is gaining an idea of clinical areas that you can improve on as a physician in order to improve your patient’s outcomes.