General urologists are less likely to utilize third-line interventions for overactive bladder than those with additional female pelvic medicine and reconstructive surgery (FPMRS) training.
A greater deployment of carepaths and up-front patient education early in the patient-clinician relationship may help improve care in patients requiring third-line therapies, according to researchers at the Cleveland Clinic, who presented their findings at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction winter meeting in Austin, TX.
The authors conducted a retrospective study that included 11,516 patients (mean age, 62 years) and they found that loss to follow-up was common in this cohort, which was 54% male. The authors reviewed the use of third-line therapies (sacral neuromodulation, posterior tibial nerve stimulation, and intradetrusor botulinum toxin injection) for refractory overactive bladder. They examined how frequently patients were referred to these therapies by urology advanced practice providers, general urologists, and FPMRS sub-specialists.
“We hypothesized that FPMRS providers would provide third-line therapies at a much higher rate, and our data confirmed this suspicion. At our tertiary care institution, APPs (allied practice providers) did not provide any third-line therapies, and general urologists provided them to 0.7% of their OAB patients versus 14.7% of OAB patients seen by FPMRS providers undergoing third-line therapies,” said study investigator Jessica Lloyd, MD, of the Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, working with Sandip Vasavada, MD, and colleagues.
Dr. Lloyd, who presented the study findings at the meeting, said they provide a platform to encourage general urology colleagues to either offer more third-line therapies or to more quickly refer OAB patients to FPMRS sub-specialists.
“Our focus is to provide effective, expeditious care to OAB patients and avoid loss to follow-up in the setting of ineffective interventions, such as prescriptions for three and four different anticholinergic medications after the first medication failure,” said Dr. Lloyd.
In this review, all the patients were treated for a new diagnosis of overactive bladder between January 2016 and March 2017. The authors analyzed the number of follow-up appointments and the rate of referral to a third-line overactive bladder therapy. The study showed that retention to a second appointment was 40% (39% for general urologists, 29% APPs, and 48% for FPMRS-trained urologists). However, it was considerably different when it came to retention to a third appointment, which was only 18% (17% general, 9% APP, 26% FPMRS). The retention to a fourth appointment was 9% (8% general, 3% APPs, 16% FPMRS).