Siobhan gave a great talk about the use of navigators in the care of overactive bladder patients. And as everybody knows, these patients often get short shrift in the office evaluation process. And after that, they sometimes get lost to care. And I think one of the great things that we can do is to use our advanced practice providers in really transforming the care of these patients from something that's casual and maybe not taken as seriously as it should, to something that's really serious in providing these patients with excellent counseling all along the path of this.
And Siobhan's an expert at this. She's organized a great talk. So we've asked her to describe exactly how this works and what the advantages and if there are any disadvantages are to this approach. So Siobhan, take it away.
Siobhan Hartigan: Great. Thanks so much, Alan. Appreciate that kind introduction. So we'll be talking a little bit about navigators transforming overactive bladder care. And this is really influenced by that panel that Alan was referencing at SUFU this year, 2026. I had two other panelists with me, Dr. Goudelocke and Dr. Gaines. And really, we all have different types of practices. And so we highlighted the way that each of us have used navigators in our own practice and what that might look like so that you can help to implement that regardless of what kind of practice you have.
So first and foremost, we know overactive bladder is very prevalent and often undertreated. 33 million Americans live with overactive bladder symptoms. That number is likely to rise. And many, many patients do not even seek treatment. Very frequently due to embarrassment, lack of access to a specialist, being dismissed, a physician might not ask about their symptoms. They might consider it a normal part of aging. And what's worse is if patients finally get the courage and bring it up in a visit and then it's just dismissed or they're given just one option and it doesn't work for them, they oftentimes feel like they just need to live with their symptoms.
So we know that there's a high attrition in this space. 82% of patients are non-adherent to overactive bladder medications by 12 months and then nearly three quarters of patients don't return for a third visit when talking about their overactive symptoms and addressing them.
So why? Why do we need navigation here? Well, because what we've done really wasn't working. Those high attrition rates. They're very frequently points of failure even with an overactive bladder care pathway and we're losing these patients. And they're going on with their lives, just really suffering without treatment. So the goal of navigation is to improve patient outcomes by providing personalized support, education, and efficient access to care.
So we're moving from a paradigm shift of reactive care for these patients to be more proactive, intervening sooner, bringing them back in. And overactive bladder navigation can look really different regardless of where you are, what your practice is set up as, and the staff that you might have.
So first and foremost, we need to define the role of a pelvic health navigator. They can come from a variety of clinical backgrounds. They don't necessarily need to be an advanced practice provider. Certainly someone with some clinical knowledge is very helpful. But regardless of your type of practice, you can really train anybody to do this to help be an extender review as you talk about overactive bladder treatments. So there are some people that have a nurse practitioner doing this, some people have an RN or an LPN. And you can even have a motivated MA take on this role for your practice.
What's really important is this is going to be a job for them. So you need to secure buy-in from your practice, your partners, your hospital system that this actually has value. And what we've seen time and time again is that having a navigator in the OAB space truly does add value. You can prove ROI of this position with one to two additional PNEs a year. So it's very easy to get a lot of procedures out of bringing these patients back in, moving them on to minimally advanced therapies for overactive bladder and just making sure that you're moving them along the pathway.
It's important to show value to your partners or the system, whoever is making the financial decisions. And with some assistance, this is pretty easy to do by running just a quick pull of case numbers, patient numbers, and how many patients you're being lost to follow up and being undertreated.
As you bring in a navigator, you want to make sure that you understand how they're going to be incorporated into the practice. Are they only going to be working with one physician, one provider, or are they going to be managing all the patients for the practice? And if they are managing everyone, all the overactive bladder patients for the practice, developing a really nice protocol and workflow for the navigator is super helpful to keep things consistent, knowing when those touchpoints might be and when you want to see them back in the office.
So navigation, as I mentioned, can look several different ways. Over here is the graphic for the SUFU OAB guidelines. So really moving towards a shared decision-making approach. Incorporating that into the navigator's pathway as they move through the process with the patient is so helpful. So you develop an outline and develop how you want to track the patient's progress. This doesn't have to look the same for everybody. Some people have them touch base in four weeks, some do six weeks, some do three months, although I would say that earlier tends to be better before patients get very discouraged and lose hope.
There are so many hurdles to overcome on this pathway. For example, insurance coverage for beta-3 adrenergic agonists, side effects from any medications, non-adherence using vaginal estrogen. These are all barriers that patients face. And so having an earlier touchpoint so that you can keep moving them along the pathway can be very helpful.
It doesn't have to be fancy the way that you track their progress. This looks very different across practices too. Some people have a HIPAA-compliant Excel sheet. Some people have communications that are sent via Epic. You can incorporate it through an EMR. You can task somebody every time you see an OAB patient. Whatever works for you is okay to do. You just want to consistently have a way that your navigator knows how to find that information and get in touch with the patients.
A really good use of telehealth can be used in navigation for OAB. For some reason, patients are much more brief on a telehealth visit than they are when they come into the office. And for a quick little touchpoint for OAB navigation, telehealth might be an excellent utilization of your time, the patient's time, a navigator's time, and also you can think about the productivity that can come from a telehealth visit as well.
So really, the take-home message here is that navigation for overactive bladder does not have to be fancy or complicated. The big thing is to just get started. And you will help your practice, your institution, and most importantly, your patients by incorporating this so that you can help to reach more patients and get them to a treatment that's really sufficiently treating their quality of life symptoms.
Alan Wein: Listen, that was an excellent presentation and a great summary of the panel discussion. So who do you think this falls to most appropriately? And as far as the alternatives that you listed, nurse practitioner, RN, practical nurse, medical assistant?
Siobhan Hartigan: We really want everyone to be operating to the top of their license. And so we want to utilize the staff that we have, which there's never enough staff, to the best of our ability. A nice thing about having an APP be your nurse navigation is all of the billable visits that you can get out of the navigation. And so that can be really beneficial for them.
They can also help with any counseling that might need to take place if you're moving them on to an advanced therapy option. So there are some practices where the physician might meet the patient, have a nice conversation, an outline of the treatment options available. The patient might choose to do some conservative therapy and a medication. And then their next touchpoint is an APP. And the APP can move them along, maybe try a different medicine, but if they're not happy, they can counsel them about an implantable tibial option or chemodenervation or sacral neuromodulation. And there are some practices where the APP will even schedule them for that next treatment option and then the physician can do it.
So that's very reasonable. If you have limitations in terms of APP availability, really having an MA just make a quick phone call that says, "How are you doing? Oh, you stopped your medicine. Let's get you back in." It can really be as simple as that. Just having somebody reach out that proactive versus the scheduling the patient for a return visit, then something comes up, they cancel their appointment and then you don't see them again.
Alan Wein: Yeah. As you probably remember, when I was at Penn, I had a woman named Bernice McPherson who, I mean, she was a nurse practitioner, but she was great. She managed the overactive bladder patients. She managed the nocturia patients, which is, I guess, another thing that they can do. And she actually managed a lot of the patients on active surveillance for prostate cancer. So I think that our responsibility, I mean yours and mine is to educate these people. And have them hang around you enough so that they understand your routine and know enough to question you if they have any doubt about anything that they're advising. Now in your practice, do they do this for patients other than overactive bladder patients or is it pretty much restricted to the overactive bladder patients?
Siobhan Hartigan: Right now it's pretty much my OAB patients. My practice has really become very sub-specialized. So I'm not doing any prostate cancer, no surveillance like that. And so really we focused on OAB and incorporating this. I definitely think another navigation point could certainly be the patients that are on vaginal estrogen for UTI prevention. That's another very frequent population that they're doing really well on vaginal estrogen, they stop it, then their UTIs come back. So I can definitely see me expanding into that space a little bit too.
Alan Wein: Yeah, I mean it's pretty incredible how much better the patients do when they're continuously or intermittently continuously in contact with somebody. So at the first visit, do you tell the patients that this is going to happen that, "Hey, there's going to be another person involved in your care"? I mean, how do you transfer some of the authority from you to that person?
Siobhan Hartigan: Yeah, so that's definitely something that I think at first I struggled with because the patients are there to see you and they want to hear it from you. But I think one thing that we know is if you lay out the pathway for the patients at the first visit, I mean, that's when I know that they're there. If they've gotten in, I can lay out the whole pathway and really try to instill hope in them because a lot of these patients by the time they come to you have been suffering for years. And so if you can instill a little bit of hope that, "Hey, listen, this is what we're doing today, but these are all of the other options that you have available for you." I like to definitely make sure I talk about that at the first visit.
And then I also lay out to them that they're going to touch base with my APP, she's going to ask them how they're doing. If they're doing great, excellent. If not, we're going to move on to something else. And we're going to keep going until we can improve their quality of life to the best of our ability and to their satisfaction.
So I really do lay it out there for them at the initial visit. The patients don't seem to be upset about that at all. I think they're very happy that someone's taking an interest in them, they feel well taken care of. And then I routinely have a touchpoint back with them as well. It's not like, "Oh, you're going to go down this pathway and never see me again." So I do like to see these patients again, but we run out of the capacity to see them as soon as we really want to. So it's nice to have that.
Alan Wein: Yeah. So are these people paid by the practice, by the hospital?
Siobhan Hartigan: Yeah, so employed by everybody else that pays us, so they're employees, but they do have productivity targets and so they're billable visits.
Alan Wein: So they're paid by your practice or the hospital?
Siobhan Hartigan: Yeah, the hospital system.
Alan Wein: Ah, okay. So in order to make it worthwhile for the hospital, I guess it's best for them to have somebody do it who, as you said before, can actually bill for their visits at least if not completely, then partially what your fee would be?
Siobhan Hartigan: So that's one way to do it, but you can even justify to the hospital system if they're paying the salary of an MA, you can justify it by saying, "Look, if we get two to three more patients and do a basic evaluation for sacral neuromodulation in a hospital or an ASC setting that they get some revenue from, that's going to pay their salary for the year."
And so if you can show that their everyday work of navigation for OAB will give you even just a few more procedures, if you run those numbers, it's pretty easy to see the financial benefit of having a navigator. Some of the industry partners can actually run those numbers for you and do a proforma for what the value add would be and what the financial gain of the institution would be if you did X number of procedures. So I would say leverage any industry partnerships that you might have, regardless of the company, they should be able to provide that information.
Alan Wein: That's great. Well, that's really useful knowledge. I hope that people who watch this will listen and follow your model because I think it's a great model. I think it serves the patients by getting more of them seen, by taking better care of them. And they have an additional person to call if they have a problem and develop a close relationship with them. So thanks so much. Great.
Siobhan Hartigan: Absolutely, Alan.
Alan Wein: Take care. Right.
Siobhan Hartigan: Thanks, you too. Great seeing you.