• The Men’s Genitourinary and Sexual Health initiative simultaneously targeted online educational interventions to HCPs and patients/caregivers to improve communication around GU issues and sexual health during routine office visits.

• HCP and patient/caregiver participants exhibited significantly improved confidence, competence, and performance across several topic areas after engagement in the activities.

• By aligning the concepts and key messages presented to HCPs and patients/caregivers, the curricula helped foster an open and engaged partnership between HCPs and patients.

• Additional educational curricula are being developed to address ongoing gaps in men’s GU and sexual health.

• This model has merit and applicability in several other therapeutic areas, including the care of chronic conditions such as hepatitis C and HIV infection, diabetes, menopause, contraception, and many others.

Discussion and Next Steps Acknowledgements

References

Matt T. Rosenberg, MD1; Caroline Robinson, PhD2; Greg Salinas, PhD3; Simi T. Hurst, PhD4 Mid-Michigan Health Centers, Jackson, Michigan, USA; 2Genentech, San Francisco, California, USA; 3CE Outcomes, LLC, Birmingham, Alabama, USA;

Medscape, LLC, New York, New York, USA

Maximizing Provider-Patient Alignment: Provider Education and Patient Engagement in Men’s Genitourinary and Sexual Health

• Patients and healthcare providers (HCPs) often incorrectly attribute lower urinary tract symptoms (LUTS), benign prostatic hyperplasia (BPH), and/or sexual dysfunction to normal aging, leading to underdiagnosis and undertreatment.

• Both groups are reluctant and/or lack confidence to discuss these potentially “embarrassing” topics.1-3

• Prior research suggests that online education can improve application of evidence-based medicine.4

• This study evaluated if a series of online educational interventions – with one a curriculum directed to HCPs and a complementary curriculum directed to patients/caregivers – could:

– Improve competence and performance among primary care providers (PCPs) and urologists in the identification and management of men with genitourinary (GU) and sexual health concerns,

– Foster development of a care plan encompassing treatment of GU/sexual health symptoms and underlying medical or comorbid conditions, and

– Facilitate effective dialogue between clinicians and patients, leading to more collaborative interactions.

Research Design and Interventions

Results

• Three continuing medical education (CME)/continuing nursing education (CE)-certified, online educational interventions were developed to address different gaps in the care of men with GU and sexual health concerns.

– Simple Approaches for Assessing Men’s Genitourinary and Sexual Health

– Overactive Bladder, Benign Prostatic Hyperplasia, or Something Else? Applying Treatment Algorithms

– Exploring ED and Hypogonadism as a Portal to Bone, Cardiovascular, Hormonal, and Metabolic Health

• Each intervention consisted of a video-based presentation delivered by a clinical expert, synchronized slides, interactive questions, and a downloadable transcript (with embedded slides).

• Three corresponding patient/caregiver-focused online education and engagement modules – designed to empower and motivate patients to discuss GU and sexual health concerns with HCPs – were developed.

– Sexual and Urinary Health: What to Expect As I Age

– How to Keep an Enlarged Prostate in Check

– Testosterone: Sex, Vitality, and Health• Each module was developed to be

visually engaging and included simple-to-read text, graphics, interactive questions, and video vignettes.

• Each module contained matching pre- and post-assessment questions that evaluated knowledge transfer and overall attitudes toward:

– Knowledge of men’s health, – Engaging in discussions with HCPs, and – Taking action to address urologic and sexual health concerns.• Participants were stratified into 3 categories for analyses: – Individuals with an established diagnosis of GU or sexual health dysfunction, – Individuals without an established diagnosis, and – Significant others.

• The impact of each educational intervention on clinical practice was evaluated using previously validated case-based survey methodology.5-7

• Survey content focused on the application of current evidence-based recommendations for the assessment and management of patients with GU and sexual health concerns.

• Each survey question was aligned to a defined learning objective and a key measurement indicator (or statement of healthcare performance expectations).

• Participant responses were collected and compared with a demographically matched control cohort of physicians who had not participated in any of educational interventions.

– Nonpracticing clinicians and those reporting “0” patients with men’s health issues were excluded from the analysis.

• Data were collected during the first 3 months following the online launch of each activity and analyzed in aggregate to maintain confidentiality.

– IBM SPSS Statistics 2.0 was used in data management, extraction, transformation, and statistical analyses. This aligned initiative was funded through an independent educational grant from Lilly USA, LLC. For additional information,

please contact Simi T. Hurst, PhD, Director Clinical Strategy, Medscape, LLC, shurst@medscape.net.

HealtHcare Provider interventions

HealtHcare Provider results

Patient/caregiver results

HealtHcare Provider assessment

Patient/caregiver assessment

Patient/caregiver interventions

• 37,800+ HCPs have participated in the HCP-focused interventions and 12,000+ have completed CME post-tests

• Analyses revealed that participant physicians were significantly more likely than nonparticipants to make evidence-based decisions and exhibited:

– Increased knowledge of men’s health issues, – Increased comfort in discussing related sexual health

topics, and – Improved ability to detect and differentiate abnormal

urinary and sexual symptoms.• The overall effect sizes for each of the HCP interventions

were d=0.39, d=0.5, and d=0.9, indicating a moderate to large impact for 2 of the educational interventions.

• 16,800+ patients and/or caregivers have participated in patient/caregiver interventions and 4,800+ have completed both pre- and post-assessment questions

• Following participation in the patient/caregiver interventions, individuals:

– Had significantly improved understanding of men’s GU health,

– Were significantly more likely to recognize signs and symptoms associated with an enlarged prostate and low testosterone,

– Intended to take action, either by scheduling an appointment with their HCP or by discussing these symptoms with their HCP at their next scheduled appointment, and

– Had increased comfort in communicating with their HCP about urinary and sexual health issues:

• Established diagnosis (n=142), 62%-68%; • No diagnosis (n=422), 73%-77%; • Significant other (n=66), 40%-56%

Table 2. HCP Results: Physician Participants Were Significantly More Likely Than Nonparticipants To Make Evidence-Based Decisions

PcPs (ParticiPants, n=70; nonParticiPants, n=70) nonParticiPants ParticiPants P value

Use appropriate assessments to diagnose prostate-related LUTS 31% 59% .001

Select the appropriate test for diagnosing OAB 41% 66% .004

Recognize the risk of systemic vascular disease associated with erectile dysfunction 51% 81% <.001

Develop an appropriate management strategy for patient with OAB and bladder outlet obstruction 33% 51% <.03

Correctly evaluate the risk between hypogonadism and co-occurring or associated conditions such as COPD, anemia, and osteoporosis

3% 31% <.001

Determine the correct methodology for evaluating testosterone levels 27% 57% <.001

Develop a timely and appropriate monitoring plan for patients receiving testosterone therapy 13% 29% .02

Urologists(ParticiPants, n=30; nonParticiPants, n=30) nonParticiPants ParticiPants P value

Correctly evaluate the risk between hypogonadism and co-occurring or associated conditions such as COPD, anemia, and osteoporosis

3% 20% .05

Determine the correct methodology for evaluating testosterone levels 53% 83% .01

Develop a timely and appropriate monitoring plan for patients receiving testosterone therapy 3% 23% .03

COPD = chronic obstructive pulmonary disease; HCP = healthcare provider; LUTS = lower urinary tract symptoms; OAB = overactive bladder; PCP = primary care provider This pilot analysis uses data from 210 PCPs (n=70 per cohort) and 90 urologists (n=30 per cohort) who participated in at least 1 online intervention and the corresponding post-intervention survey assessment during the first month following online intervention launch.

Table 3. Patient/Caregiver Results: Patients and caregivers exhibited significant knowledge gains and were more likely to discuss GU concerns with HCPs

table 1. HCP Study Population: Number of Patients Seen Per Week With Men’s Health Issues

PCP PartiCiPant

(n = 70)

PCP nonPartiCiPant

(n = 70)

Urologist PartiCiPant

(n = 30)

Urologist nonPartiCiPant

(n = 30)

Activity 1: Simple Approaches for Assessing Men’s Genitourinary and Sexual Health

1-10 0% 0% 9% 9%

11-20 10% 10% 27% 33%

21-30 7% 7% 21% 14%

31-40 3% 3% 21% 14%

>40 80% 80% 21% 30%

Activity 2: Overactive Bladder, Benign Prostatic Hyperplasia, or Something Else? Applying Treatment Algorithms

1-10 26% 26% 0% 0%

11-20 56% 56% 7% 7%

21-30 9% 9% 17% 17%

31-40 4% 4% 17% 17%

>40 6% 6% 60% 60%

Activity 3: Exploring ED and Hypogonadism as a Portal to Bone, Cardiovascular, Hormonal, and Metabolic Health

1-10 17% 13% 3% 3%

11-20 30% 26% 3% 3%

21-30 21% 23% 3% 3%

31-40 13% 13% 20% 17%

>40 19% 26% 70% 73%

Pre-ParticiPation Post-ParticiPation P value

Differentiate between normal and abnormal symptoms of aging Established diagnosis (n=36) 35% 59% <.001

No diagnosis (n=108) 51% 73% <.001

Significant other (n=25) 36% 64% .05

Understand the symptoms and significance of having an enlarged prostate

Established diagnosis (n=183) 61% 73% <.001

No diagnosis (n=216) 60% 75% <.001

Significant other (n=36) 53% 72% .02

Understand the symptoms associated with low testosterone

Established diagnosis (n=142) 80% 89% .004

No diagnosis (n=422) 73% 86% <.001

Significant other (n=66) 67% 80% .02Data were gathered from the 1244 patients/caregivers who participated in at least 1 activity and completed both the pre- and post-assessment questions.

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3. Shindel AW, Ando KA, Nelson CJ, Breyer BN, Lue TF, Smith JF. Medical student sexuality: how sexual experience and sexuality training impact U.S. and Canadian medical students’ comfort in dealing with patients’ sexuality in clinical practice. Acad Med. 2010;85:1321-1330.

4. Andolsek K, Rosenberg MT, Abdolrasulnia M, Stowell SA, Gardner AJ. Complex cases in primary care: report of a CME-certified series addressing patients with multiple comorbidities. Int J Clin Pract. 2013;67:911-917.

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Background and Objectives

ED = erectile dysfunction; HCP = healthcare provider