Patient Navigation for Overactive Bladder Improves Access to Care - Beyond the Abstract

Overactive bladder (OAB), or urinary urgency, with or without urinary incontinence, affects a large percentage of the United States population. In fact, it is estimated that over 33 million Americans suffer from symptoms of OAB.1 OAB represents a chronic condition that can be frustrating for both patients and clinicians alike. Patients become frustrated as medical therapy can be expensive, ineffective, and lead to irritating side effects. As a result, many patients will not return to the office once they become discouraged with treatment failures and this leads to a lack of exposure to the alternative treatment options, such as neuromodulation or Botox.

A care pathway is an effective way for clinicians to communicate to patients what their treatment options are and develop an individualized plan. Nurse navigators are trained to call patients via telephone, track progress, and make treatment decisions based on a standardized flowchart. For clinicians, this can reduce the time spent counseling patients in the office and for patients, this may eliminate unnecessary visits, expense copays, and travel to the office. We report our results using our pilot navigation pathway for the treatment of OAB.

We compared two groups with 535 patients in total. The first group (431 patients) were placed on the navigation pathway and were able to be reached via telephone. The second group (104 patients) were those placed on the navigation pathway, but were not able to be reached and did not complete navigation. Using navigation we were able to increase the amount of patients trialed on more than one medication, 43% of the navigated group trialed a second medication, compared to 23% of those not navigated. Furthermore, it is estimated that only 5% of OAB patients will undergo third-line therapy.2 In our cohort, the patients who followed the navigation pathway, third-line therapy was utilized in 24%, representing a 600% increase from the national average.

Genitourinary surgeons are able to offer minimally invasive surgical treatments to those patients suffering from OAB when symptoms are refractory to other treatments. By implementing patient navigation pathways, providers can expose more patients to third-line therapies and retain patients in the practice.

Written by: Greggory Peifer, DO, Urologist, Wyoming, Michigan; and Matthew Rohloff, DO, Urological Surgery Resident Physician, Metro Health-University of Michigan Health-Wyoming, Wyoming, Michigan

References:

  1. Stewart, W. "The prevalence and impact of overactive bladder in the US: results from the NOBLE program." Neurourol Urodynam. 20 (2001): 406-408.
  2. Sexton, C. C., S. M. Notte, C. Maroulis, R. R. Dmochowski, L. Cardozo, D. Subramanian, and K. S. Coyne. "Persistence and adherence in the treatment of overactive bladder syndrome with anticholinergic therapy: a systematic review of the literature." International journal of clinical practice 65, no. 5 (2011): 567-585.
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