Self management plus usual care was more effective than usual care alone for lower urinary tract symptoms in men

摘要

Health care for chronic conditions is confusing, expensive, unreliable, and impersonal. The Institute of Medicine's report, Crossing the quality chasm? recommends increasing patient control over care that empowers them to use problem solving strategies. The other options are medication or surgery. Both have significant side effects and cost.The randomised controlled trial by van der Meulen et al was well done and used a valid outcome measure relevant to clinicians who take care of patients in ambulatory settings. Patients in the study mainly had moderate and severe symptoms-severe enough to be referred to specialised urological clinics. The types of patients may differ from those treated in primary care settings in terms of severity of illness, process of care, and clinical outcomes after treatment. It is unclear whether such dramatic effects would have been seen in patients with mild symptoms. There were, however, significant reductions in treatment failure at 3, 6, and 12 months with fewer symptoms in the self management group and an extremely impressive number needed to treat of <5.This study emphasises the pdtienfs central role in the long term management of their health through effective strategies. Clinicians may find this intervention feasible, low risk, and inexpensive for routine clinical practice in patients wilh mild to moderate symptoms. It is unclear what workup was done for each patient before initiating therapy, but a complete physical exam and basic routine workup would be indicated, such as urinalysis.Further trials on larger populations will help determine whether this simple intervention with apparent lasting effects remains generalisable.