Urology Times reached out to three urologists (selected randomly) and asked them each the following question: How do you manage noncompliant OAB patients?
“First, it’s important to figure out why a patient is noncompliant. Is medication too expensive? Are there side effects? Patients are usually noncompliant, not because they choose not to take care of themselves, but because of side effects or cost.
If noncompliance is financial, that’s probably the harder issue. If people want to take medicine and can’t afford it, we have to go through insurance to find out what’s covered. In South Florida, a lot of HMOs don’t pay for a lot of medications, or older patients find themselves in the so-called doughnut hole where they reach a certain point of medication spending, insurance drops out and they can’t afford $70, $80, $90 a month.
If we’re lucky enough to have samples and it’s a doughnut-hole issue, we can maybe get them to the end of the year with samples.
If the problem is side effects, I try to move them quickly to third-line therapy if it’s appropriate.
If there are legitimate side effects after trying at least two of the OAB medicines, I go to third-line therapies. Unless there’s a contraindication, they have to try medications. ‘I don’t feel like taking it’ is not failing a medication. I explain we have to follow AUA guidelines. A lot of smart people decided this is the best way to manage patients. So they have to try it.
I’m not going to third-line therapy just because someone doesn’t feel like taking a pill.”
Yvonne Koch, MD
Miami Beach, FL