Expert discusses care-seeking attitudes in patients with overactive bladder


“Concerningly, when we look at our community population, more than a third just didn't know where to go,” says Raveen Syan, MD, FPMRS.

In this video, Raveen Syan, MD, FPMRS, discusses differences in care-seeking attitudes among patients with overactive bladder. Syan is an assistant professor in clinical urology at the University of Miami Desai Sethi Urology Institute in Miami, Florida.


What are the reasons why minority women are less likely to receive care? We know it's not because they're less likely to have overactive bladder, and we know that it's not because they're less likely to have less bother. So why do they receive less treatment? That's where we have to think beyond the scope of our traditional factors that we think influence receiving care. As I mentioned, severity of symptoms doesn't seem to be a major impact. Socioeconomic barriers, we have shown that even when you control for these factors, minority women are less likely to receive care. So what about things like differences in care-seeking attitudes among minority women? Provider bias—what are reasons why maybe physicians don't offer therapies to minority women? Perhaps there's a lack of knowledge and understanding among minority women that's different compared with non minorities. And then we have to talk about social determinants of health. We have seen that minority women are less likely to seek care. This is an interesting study that basically showed when you look at women with all pelvic floor disorders, they were less likely to seek care for a urinary incontinence complaint compared with White women. This is a study looking at a fairly large number of Asian women and compared them with White women. And they show that with women with weekly incontinence, which is significant incontinence, only a third of them told doctors they have this issue. When we try and tease out why women are not likely to report the care, we really have to do population-based studies. And this is a study I did that was funded through the American Urological Association Research Scholar Award, where I performed a population-based survey recruiting only minority women. So this included Black women, Hispanic women, and women who identified as "other" with all pelvic floor disorders. We recruited from our academic clinics here at the University of Miami, our safety net hospital clinics, and then most importantly, we collected from our mobile clinics. These are literally mobile vehicles that go to underserved areas in Miami-Dade County, and provide education, awareness, counseling—all pro bono. This allows us to really compare a more community-based, underserved area. Part of what we asked was, why did you not receive treatments for pelvic floor disorders? And we gave them some options to describe. What we found is most commonly patients didn't know where to go, even living in a populous county, like Miami-Dade County, and having these safety net hospitals, they just don't know where to even begin. A lot of them did put it off, so it was a lower priority. And cost impacted more than 14% of these patients, which is very concerning, because a lot of treatments for pelvic floor disorders and overactive bladder can be done without payment; it could be conservative management. When we look by race, we found that Hispanic women were most likely to put it off, didn't know where to go, and cost was a major factor. When we look at Black patients, again, not knowing where to go was the biggest issue—affecting a third of these patients, not being bothered enough, and cost. When we look by location, when we look at our own clinics, more than a quarter of them didn't know where to go. When we look at the safety net hospital, again, [patients reported being] not bothered enough. That's interesting; for whatever reason, their symptoms don't bother them enough that they're going to go seek care, perhaps because it's more challenging to seek care for these patients. Language was a barrier for a fifth of these patients, which is very alarming because here at the University of Miami, we offer full-language services in Spanish, but patients have a perception that they're not going to be understood, and perhaps that's part of why they don't seek care. And not knowing where to go remained a factor in 20%. Concerningly, when we look at our community population, more than a third just didn't know where to go. Cost impacted a quarter of them; that is why they did not seek care. Not trusting doctors was a major impact. So clearly, there's a breakdown in the provider-patient relationship here among this population.

This transcript was edited for clarity.

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