PD26-08 POPULATION BASED EVALUATION OF LABORATORY MONITORING AFTER PRESCRIPTION FOR TESTOSTERONE THERAPY
Bibliographic record
Abstract
INTRODUCTION AND OBJECTIVE: The testosterone guidelines from both the Endocrine Society and American Urological Association recommend follow-up after starting testosterone therapy with serum testosterone, hemoglobin (or hematocrit), and prostate specific antigen (PSA) within one year. We hypothesized that management patterns differ between prescribing practitioner type. METHODS: We performed a population-based study of men >66 years of age that were newly treated with testosterone replacement therapy between the years 2008 and 2015 in Ontario, Canada using the Ontario Drug Benefit database and the Canadian Institute for Health Information. Patient age, type of therapy, practitioner type, and laboratory value data were extracted. We defined guideline adherence as a measurement of testosterone, hemoglobin (or hematocrit), and prostate specific antigen (PSA) within one year of testosterone prescription. Comparisons between these values across prescription year were evaluated. Proportional data was evaluated using a Chi-Square test on PRISM 8. RESULTS: A total of 15,503 men >65y received testosterone therapy between 2008 and 2015. Testosterone therapy prescriptions peaked in 2013 at n=2,434 and declined to n=1,831 in 2015. The majority of patients were between 66-70 years of age (61%, n=9,387), followed by men aged 75+ (23%, n=3,568), and men aged 71-74 (16%, n=2,548). Testosterone therapy included topical gels (48%, n=7,490), oral (27%, n=4,187), injections (23%, n=3,551), and patches (2%, n=275). Practitioners including general practitioners/family practice (67%, n=10,358), urologists (15%, n=2,387), and endocrinologists (6%, n=865) were the top three prescribing specialties. Guideline adherence amongst all practitioners improved from 2008 at a rate of 16% to a peak of 63% in 2014 but declined to 49% in 2015. Peak guideline adherence was different amongst each top prescribing specialties (p<0.05) and was led by Urologists in 2014 at 80%, followed by Endocrinologists at 64%, and GP/FP at 59%. This discrepancy was likely due to lower PSA test rates amongst GP/FP (73%) and endocrinologists (66%) compared to Urologists (86%; all in 2014). CONCLUSIONS: Appropriate laboratory management, defined as a laboratory test for testosterone, hemoglobin (or hematocrit), and PSA within one year of testosterone prescription was best achieved by Urologists and less than half the general practitioners. The decline in frequency of PSA testing among general practitioners prescribing testosterone therapy could reflect the practice pattern of decrease in prostate cancer screening. Source of Funding: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".