Patient navigation for overactive bladder improves access to care
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Abstract
Introduction and hypothesis
Patients with overactive bladder (OAB) become discouraged with medication therapy because of the side effects, minimal subjective improvement and costs of therapy. With the implementation of a patient navigation pathway there is increased communication, subsequently leading to increased patient retention rates and utilization of third-line therapies.
Methods
This was a quality improvement study carried out over a 17-month period comparing utilization of a navigation pathway versus patients without navigation. The data were obtained using an online database (PPS Analytics) to compare medication use, cystoscopy, urodynamic studies, use of third-line therapy, and return visits.
Results
A total of 535 patients were included in the analysis and broken down into two respective groups. Group 1 were those placed on the navigation pathway and able to be reached via telephone (n = 431). Group 2 were those started on the navigation pathway who were not able to be reached via telephone, but were chart reviewed by a navigator (n = 104). Third-line therapy usage for groups 1 and 2 was 24% and 11% respectively. Return visits for additional OAB management for groups 1 and 2 were found to be 71% and 50% respectively.
Conclusion
Patient retention levels and utilization of third-line therapies are significantly improved when utilizing a navigation pathway. With 24% of the patients included in this study opting for third-line therapy, this represents a 600% increase in third-line therapies over national averages.
Keywords
Overactive bladder Patient navigation Care pathwayAbbreviations
- AUA
American Urological Association
- FPMRS
Female pelvic medicine and reconstructive surgery
- OAB
Overactive bladder
- SUFU
Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction
- UDS
Urodynamic studies
Notes
Compliance with ethical standards
Conflicts of interest
There are no conflicts of interest in the publication of this article.
References
- 1.Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4–20.PubMedGoogle Scholar
- 2.Stewart W, Herzog R, Wein A, et al. The prevalence and impact of overactive bladder in the U.S.: results from the NOBLE program. Neurourol Urodyn. 2001;20:406–8.Google Scholar
- 3.Gormley EA, Lightner DJ, Faraday M, Vasavada SP; American Urological Association; Society of Urodynamics, Female Pelvic Medicine. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol. 2015;193:1572–80.CrossRefPubMedGoogle Scholar
- 4.Zimmern P, Litman HJ, Mueller E, Norton P, Goode P. Effect of fluid management on fluid intake and urge incontinence in a trial for overactive bladder in women. BJU Int. 2010;105(12):1680–5.CrossRefPubMedGoogle Scholar
- 5.Sexton CC, Notte SM, Maroulis C, et al. Persistence and adherence in the treatment of overactive bladder syndrome with anticholinergic therapy: a systematic review of the literature. Int J Clin Pract. 2011;65(5):567–85.CrossRefPubMedGoogle Scholar
- 6.Yu YF, Nichol MB, Yu AP, Ahn J. Persistence and adherence of medications for chronic overactive bladder/urinary incontinence in the California Medicaid program. Value Health. 2005;8(4):495–505.CrossRefPubMedGoogle Scholar
- 7.Yeaw J, Benner JS, Walt JG, Sian S, Smith DB. Comparing adherence and persistence across 6 chronic medication classes. J Manag Care Pharm. 2009;15(9):728–40.PubMedGoogle Scholar
- 8.Hartigan S, Fischer K, Wein A, Jaffe W. High attrition rate and low progression to advanced therapy for patients with overactive bladder: a hospital system wide study. Neurourol Urodyn. 2018;37(Suppl 1):S576–7.Google Scholar
- 9.Lloyd J, Guzman J, Giusto L, et al. Trends in third line therapy utilization for overactive bladder amongst general urologists, advanced practice providers, and FPMRS subspecialists. Neurourol Urodyn. 2018;37(Suppl 1):S584.Google Scholar
- 10.Knight JC. Practitioner application: the impact of patient navigation on diabetes. J Healthc Manag. 2018;63(3):e41–2.CrossRefPubMedGoogle Scholar
- 11.English TM, Masom D, Whitman MV. The impact of patient navigation on diabetes. J Healthc Manag. 2018;63(3):e32–41.CrossRefPubMedGoogle Scholar
- 12.Serrell EC, Hansen M, Mills G, et al. Prostate cancer navigation: initial experience and association with time to care. World J Urol 2018. 2019;37(6):1095–1101.Google Scholar
- 13.Abrams P, Kelleher CJ, Kerr LA, Rogers RG. Overactive bladder significantly affects quality of life. Am J Manag Care. 2000;6(Suppl):S580–90.PubMedGoogle Scholar
- 14.Nitti V. Clinical impact of overactive bladder. Rev Urol. 2002;4(Suppl 4):S2–6.PubMedPubMedCentralGoogle Scholar
- 15.Milsom I, Abrams P, Cardoza L, et al. How widespread are the symptoms of overactive bladder and how are they managed? A population-based prevalence study. BJU Int. 2001;87:760–6.CrossRefPubMedGoogle Scholar
- 16.Schabert VF, Bavendam T, Goldberg EL, Trocio JN, Brubaker L. Challenges for managing overactive bladder and guidance for patient support. Am J Manag Care. 200915 (4 Suppl):S118–22.Google Scholar
- 17.Moskowitz D, Adelstein SA, Lucioni A, Lee UJ, Kobashi KC. Use of third line therapy for overactive bladder in a practice with multiple subspecialty providers—are we doing enough? J Urol. 2018;199(3):779–84.CrossRefPubMedGoogle Scholar