Diagnostic and treatment strategies for erectile dysfunction: the ‘Process of Care’ model

Abstract

The new era of erectile dysfunction medicine ushered in by the availability of an effective and safe oral medication paves the evolution of the field toward a multi-disciplinary and primary care setting. There exists a paucity of guidelines regarding the assessment and management of the patient with erectile dysfunction in the primary care arena. The ‘Process of Care’ model for the evaluation and treatment of erectile dysfunction has been developed to advance new guidelines for the diagnosis and management of erectile dysfunction in the primary care and multi-disciplinary setting. This model was developed under the auspices of the University of Medicine and Dentistry of New Jersey (UMDNJ)-Robert Wood Johnson Medical School (chairman: R Rosen) with input from a multi-disciplinary group of experts including representation from primary care, internal medicine, endocrinology, psychiatry, psychology and urology.^†

The methodology employed was a modified delphi-technique (RAND method). The key components of the model are:

• a rational approach to diagnosis and treatment

• emphasis on clinical history-taking and a focused physical examination

• specialized testing and referral in pre-defined situations

• step-wise management approach with ranking of treatment options and

• incorporation of patient and partner needs and preferences in the decision making process when possible (a goal-directed approach).

The management algorithm is conceptually organized into progressive stages from Process→ Action→ Outcome.

^†Process of Care panelists included: R Rosen, University of Medicine and Dentistry of New Jersey; Panel Chairperson; I Goldstein, Boston University School of Medicine; J Heiman, Unversity of Washington School of Medicine; S Korenman, University of California, Los Angeles; M Lakin, Cleveland Clinic Foundation; T Lue, University of California San Francisco; DK Montague, Cleveland Clinic Foundation; H Padma-Nathan, University of Southern California; R Sadovsky, SUNY Brooklyn; RT Segraves, Case Western Reserve; and R Shabsigh, Columbia University School of Medicine.