The process of care model for evaluation and treatment of erectile dysfunction. The Process of Care Consensus Panel.

This paper addresses pertinent issues concerning the role of physicians in the assessment and treatment of men with complaints of erectile dysfunction. With the availability of safe and effective oral drug therapy, the field of erectile dysfunction has expanded rapidly to encompass multiple disciplines and specialties. Recognizing the need for evidence-based standards and guidelines in the management of this common disorder, a multidisciplinary panel of experts was convened to examine existing literature and practice standards. This panel employed a modified Delphi methodology to develop consensus on definition and classification, rational utilization of diagnostic and therapeutic options, and clinical guidelines for the management of erectile dysfunction in a primary care setting. A 'Process of Care Model for Erectile Dysfunction' was thus developed, incorporating a step-wise decision making approach, defined in terms of relevant processes, actions and outcomes. According to this method, initial assessment should include a careful clinical history, focused physical examination and selected laboratory tests. Subsequent management should be goal-oriented, taking into account patient and partner needs and preferences. The step-wise treatment algorithm is based on the selection criteria of ease of administration, reversibility, relative invasiveness and cost. In addition, common referral indications for specialized diagnostic testing and treatment are provided. By assisting the primary physician in selecting appropriate assessment tools and treatment interventions, the proposed guidelines are intended to optimize care of the patient with erectile dysfunction. The panel strongly recommends further research into the causes and associated risk factors for erectile dysfunction, prevention and the role of lifestyle modification, and the critical issue of partner-related sexual dysfunction. Considering the strong relationship between sexual dysfunction and overall quality of life, it is incumbent upon physicians to address the sexual needs of their patients in a sensitive and informed manner.