Abstract
Background: Bladder cancer is responsible for considerable morbidity and mortality. Patients commonly present with haematuria to primary care for assessment. In Canterbury, New Zealand, the first-line investigations available to primary care were changed in 2018, from urine cytology to CxBladder Triage (CxBT) and upper urinary tract imaging. This retrospective study was performed to evaluate the impact of this change in diagnostics.
Methods: A retrospective audit of routinely collected electronic data from March 2013 to December 2021 from Christchurch Hospital, New Zealand, compared the traditional primary care haematuria pathway with the CxBT haematuria pathway. The primary outcome was waiting time from primary care referral to urological specialist appointment and waiting time to first operative treatment for bladder cancer. Waiting time was further analysed for ethnicity. The secondary outcome was monthly haematuria referrals for urological specialist appointment.
Results: There were 4512 haematuria referrals during the study period. Following the introduction of CxBT to the primary care haematuria pathway, waiting time from primary care referral to urological specialist review reduced by 14.8 days and time to surgery by 15.0 days. There was a greater reduction for Māori compared with that of non-Māori patients. The monthly haematuria referrals for urological specialist appointment reduced on average by 6.9 referrals per month.
Conclusion: CxBT in primary care haematuria pathway reduces waiting time from primary care referral to urological specialist appointment and to first operative treatment for bladder cancer, whilst also reducing monthly referrals for urological specialist appointments and improving equity for Māori.