Lba01-10 disparities in Diagnosis and Referral Patterns for Erectile Dysfunction in Outpatient Settings: An Analysis Between Academic and Community Based Practices

Abstract

INTRODUCTION AND OBJECTIVE: Erectile Dysfunction (ED) affects about 52% of men between ages 40 and 70 and is an important marker of cardiovascular and metabolic disease. Streamlining the diagnosis of ED can have significant public health implications. Despite the high prevalence of ED, the number of men seeking treatment continues to lag. We aimed to compare the demographics and characteristics of men presenting with ED in 2 outpatient urology settings: an academic-based subspecialty clinic (SC) and an underserved community-based clinic (CC).METHODS: With IRB approval, new patient consultations from 10/2015 through 10/2020 were extracted from electronic records at SC and CC. Patients with <1 year follow-up or age <18 were excluded. All initial consultations with ICD-10 codes for ED were identified. Descriptive statistics and univariate analysis for demographic and clinical attributes were conducted and compared using chi-square analysis.RESULTS: Results are summarized in Table 1. 3067 men were seen at SC and 913 at CC. Based on the incidence and prevalence ED and the respective zip codes covered by these two clinics, a significantly lower number of men presented with ED during this time period. Notably, 98.9% of patients at SC were referred by another provider, whereas 93.1% of patients at CC were self-referred. Patients seen for ED at CC were more likely to be a minority racial/ethnic background, aged 41-59, have government insurance, be self-referred, have a metabolic disease, and live within the county served by the CC, but less likely to have other cardiac diseases. All differences between sites were statistically significant (p <0.0001).CONCLUSIONS: The clinic that is overwhelmingly comprised of demographic minorities depends on self-referral despite historical barriers to health care advocacy. The challenge for urologists, referring physicians, and policymakers is to understand the social determinants that limit primary care referral for ED and to educate stakeholders that early diagnosis of ED is intrinsic to systems-based high quality care.