The iQudos LUTS Medical Service provides the expert diagnostics and management advice in the GP setting reducing the need to refer to hospital care.
Previous sites have found that 1.4% males over the age of 60 years will present with benign prostate symptoms per year. Based on population statistics for a given area the number of new presentations per annum can be derived for each health community. The mean number of follow ups per patient is 2.5 over an 18 month period. Each clinic will accommodate a maximum of 6 and a minimum of 4 new/follow up patients. Suggested frequency of the LUTS clinics will be between 2 and 6 weeks (to be locally negotiated based on number of new presentation per annum for the given population).
The Lower Urinary Tract Symptoms (LUTS) Service
This NHS service will be delivered by iQudos Medical Services Ltd. Clinics will be staffed by an iQudos Registered General Nurse who is also fully trained in the use of the iQudos clinical decision support software (CDSS). The Company retains a full record of nurse registration status, mandatory and supplementary training. All employees and third parties are required to comply with Company Policy and Procedures when caring for patients, and handling sensitive records and information. Under the new service provision, patients presenting to their GP with suspected benign prostate symptoms can be referred to an iQudos LUTS clinic. At the point of referral the GP will organise pre investigations: serum PSA, routine chemistry; and will give the patient a LUTS questionnaire.
Having been referred by the GP, the practice receptionist books the patient into an iQudos LUTS clinic (hosted at the practice). iQudos will contact the practice for clinic referral updates and supply resource to run the clinic.
The patient(s) attends the iQudos clinic at his GP practice. The results of the GP requested tests will be made available to the iQudos nurse. The nurse will check the focused urological history questionnaire in order to gauge the severity of the symptoms. The nurse will then take a more general history looking for factors that might affect urological health or treatment choices. The patient will then be asked to void with a full bladder into a flow rate machine, immediately afterward he will have his bladder scanned to check for a post micturition residual. The nurse will then conduct a urine dipstick, and collect an MSU if indicated. The patient’s details will then be entered into the clinical decision support system (CDSS).
The CDSS produces a print out that is written in the form of a traditional letter. This GP communication will contain a summary of the findings and presentation and will contain recommendations for: the future management; treatment; follow up and relevant further investigation. These recommendations are based upon the latest protocols supplied by BAUS and NICE incorporated into the CDSS (see table below).
The BAUS/NICE Guidelines for LUTS
- Deliver a high quality, safe, local service
- Provide high level expertise and technology close to the patient
- Decrease the burden of care for the GP
- Decrease demand for secondary care referral
- Deliver management of benign prostate problems using the BAUS and NICE guidelines
- Help early diagnosis of patients with prostate cancer
- Ensure that patients with haematuria are identified and referred appropriately
- Take into account the effect of factors such as age, infection and medications on PSA
- Keep patient data secure
- Ensure that patients referred to secondary care are the most appropriate
- Ensure early referral of patients who are not suitable to be managed in primary care
- Ensure that patients who do not receive benefit from medications are assessed for alternative management at the earliest opportunity
- Provide accurate regular audit feedback on service outcomes