This is a follow-up study from a multicenter, prospective, before-and after quasi-experimental, controlled trial to assess effectiveness at 36 months of an intervention designed to promote the revision and deprescribing of mirabegron in primary care in patients with overactive bladder.
Intervention included patients attended in 17 PHCs located in North Barcelona; control included patients attended in the other 34 PHCs located in South, East and West Barcelona. The primary endpoint was mirabegron review and deprescribing when GPs considered appropriate, which was measured by the percentage of change of the number of patients with treatment at 36 months compared to the baseline. The intervention consisted of meetings with all the directors of the PHCs; distribution of the infographic to the GPs; providing information regarding the intervention for urologist and gynaecologist; and review of the treatments by the GPs. A monthly follow-up was done during the first year, and every three months thereafter until month 36.
Overall, 1932 patients were included, mean age 71.6 years (female 53.8%). A total of 540 patients included in the intervention discontinued mirabegron at some point during the 36 months follow-up (540/762, 70.8%) compared to 759 patients in the control (759/1170, 64.9%), (p < 0.001). A total of 324/433 patients (74.8%) who discontinued mirabegron use at 12 months remained without pharmacological treatment at 36 months. With respect to the baseline cohort, there was a lower introduction of new patients with mirabegron in the intervention (546/762, 71.6%) compared to the control (1246/1170, 106.5%), (p < 0.001). Regarding the treated patients, there was an increase of 41.6% in the control and a slight increase of 0.8% in the intervention at 36 months, (p < 0.001).
Our data indicate that an intervention can enhance the review use of mirabegron in the primary care setting, and promote their deprescribing.
Current medical research and opinion. 2021 Feb 04 [Epub ahead of print]
Eladio Fernández-Liz, Pere Vivó-Tristante, Antonio Aranzana-Martínez, Ma Estrella Barceló-Colomer, Maria Larrosa-Garcia, García José Luís Del Val, Elisabeth Martín Gracia, urinary incontinence improvement clinical group
Primary Health Care Barcelona, Gerència Territorial de Barcelona, Catalan Institute of Health, Barcelona, Spain., Primary Health Care Center Montcada i Reixac, Catalan Institute of Health, Barcelona, Spain., Primary Health Care Center Rio de Janeiro, Catalan Institute of Health, Barcelona, Spain., Primary Health Care Research, Evaluation and Quality Unit, Gerència Territorial de Barcelona, Catalan Institute of Health, Barcelona, Spain., Primary Health Care Service Muntanya, Gerència Territorial de Barcelona, Catalan Institute of Health, Barcelona, Spain.