The Impact of an Overactive Bladder Care Pathway on Longitudinal Patient Management.

Autor:	Selle JM; From the Division of Urogynecology., Hanson KT; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery., Habermann EB, Gebhart JB; From the Division of Urogynecology., Trabuco EC; From the Division of Urogynecology., Occhino JA; From the Division of Urogynecology., Young AD; From the Division of Urogynecology., Linder BJ
Jazyk:	angličtina
Zdroj:	Urogynecology (Philadelphia, Pa.) [Urogynecology (Phila)] 2024 Mar 01; Vol. 30 (3), pp. 330-336.
DOI:	10.1097/SPV.0000000000001479
Abstrakt:	Importance: Implementation of an overactive bladder (OAB) care pathway may affect treatment patterns and progression. Objectives: This study aimed to assess the effect of OAB care pathway implementation on treatment patterns for women with OAB. Study Design: This retrospective cohort study evaluated women with OAB, before (January 1, 2015-December 31, 2017) and after (January 1, 2019-December 31, 2021) care pathway initiation. Care pathway use included standardized counseling, early introduction of therapy, and close follow-up. Primary outcomes included OAB medication use, follow-up visits, third-line therapy, and time to third-line therapy. Results: A total of 1,349 women were included: 1,194 before care pathway implementation and 155 after. Patients after implementation were more likely to have diabetes mellitus (P = 0.04) and less likely to smoke (P = 0.01). Those managed via a care pathway were more likely to use any medication or third-line therapy within 1 year after consultation (61.3% vs 25.0%; P < 0.001). This included higher proportions receiving a medication (50.3% [95% confidence interval (CI), 41.8%-57.6%] vs 23.3% [95% CI, 20.9%-25.7%]; P < 0.001) and progressing to third-line therapy (22.6% [95% CI, 15.7%-28.9%] vs 2.9% [95% CI, 2%-3.9%]; P < 0.001). Among those who underwent third-line treatment, care pathway use was associated with shorter time to third-line therapy (median, 10 days [interquartile range, 1-56 days] vs 29 days [interquartile range, 7-191 days]; P = 0.013). Those managed via a care pathway were less likely to have additional clinic visits for OAB within 1 year after initial consultation (12.3% vs 23.9%; P < 0.001). Conclusions: Use of an OAB care pathway was associated with higher rates of oral medication and third-line therapy yet decreased follow-up office visits. Use of an OAB care pathway may promote consistent and efficient care for women with OAB. Competing Interests: The authors have declared they have no conflicts of interest. (Copyright © 2024 American Urogynecologic Society. All rights reserved.)
Databáze:	MEDLINE
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