BACKGROUND

1. Knowledge, Attitudes and Practice Among Health Care Providers in the Prevention of Recurrent Kidney Stones in Northern Ontario Bos Derek1, Abara Emmanuel2, Parmar Malvinder3 Department of Medicine, Northern Ontario School of Medicine1 Richmond Hill Urology Practice and Prostate Institute2 Department of Nephrology, Timmins and District Hospital3 BACKGROUND Kidney stones affect up to 5% of the population, with a lifetime risk of passing a kidney stone of about 8-10%. Once a kidney stone forms, the probability that a second stone will form within five to seven years is approximately 50%.Once recurrent, the subsequent risk is higher and the interval between recurrences is shortened.Thus, the recurrent nature of kidney stones underscores the importance of prevention. Effectively utilized preventive measures in the “stone clinics” have shown to reduce the 5-year recurrence rate by 60%. However, this degree of reduction in stone recurrence is not observed in the general population. . Practice pattern compliance of health care professionals to guidelines, in general is poor. Adherence to strategies to prevent kidney stones among health care providers is unknown. We conducted an online survey to assess the knowledge, attitudes, and practice patterns of health care providers regarding recurrent stone prevention. RESULTS Demographics: • 68 respondents – 72% primary care physicians • Analyzed data of homogenous group • Major Findings: • 70% of respondents were aware the current guidelines • 43% of respondents utilized their knowledge in clinical practice • Majority lacked confidence • Role of urine output: an illustrative example LIMITATIONS Low response rate Non-validated survey tool Regional variability METHODS We utilized the database of health care providers affiliated with the Northern Ontario School of Medicine. We designed the survey based on current best practice guidelines for the management of recurrent kidney stones. Questions covered three domains: (1) knowledge, (2) attitudes and (3) practice patterns. The survey was distributed electronically to all participants. General measures to prevent recurrence of stones: Increase fluid intake to produce 2–3 L of urine daily Reduced salt ingestion (<2300 mg sodium daily) Reduced animal protein intake (no more than 2 meals 
daily with less than 6 to 8 ounces per day) Moderate calcium intake (1000 to 1200 mg/day) Moderate consumption of high-oxalate content foods 
with limited vitamin C intake to <1000 mg daily Increased intake of citrate-rich fluids (i.e. lemonade, orange juice) • CONCLUSION • Most primary care physicians, though knowledgeable of appropriate preventative measures (guidelines), do not effectively apply their knowledge in clinical practice, possibly because of lack of confidence. • FUTURE CONSIDERATIONS • Validation of these findings involving a large sample size. • Methods to improve confidence among primary care providers should be further explored. • Future studies involving a larger sample size may lead to information sharing and collaborative care amongst health care providers, translating into better quality of care and cost-savings to the patient and the health care system.