Overactive bladder medication access

Objectives: The price range, insurance coverage and side effect burden of overactive bladder medications is broad and varied. Increasing awareness of side effects have resulted in more prescriptions for beta agonist and selective anti-muscarinic medications, despite cost and potential lack of insurance coverage. An internal quality improvement project was undertaken to improve patient ability to access and ultimately adhere to preferred medication therapy for treatment of overactive bladder. Preferred medication indicates the initial prescription sent to pharmacy by the provider at time of office appointment.
Data from July 2022 through September 2022 at an academic urogynecology practice shows 39.5% of patients who have a follow-up visit a month receive their preferred OAB medication.

Objective:
To increase the percent of patients per month that receive their preferred OAB medication from 39.5 percent to 45 percent at time of follow-up visit by March 2023. The resulting gap is 5.5% patients (2-3 patients).

Methods: Patients who were prescribed an overactive bladder medication from dates 1/1/2022 to 6/30/22 who also returned for follow-up visit between 7/1/22 to 9/30/22 were included for baseline data analysis.



Once data was received, the investigator performed a manual chart review to extract additional information to verify status of medication access and reasons why patients were not taking their medications. Additional calls to pharmacy and patients were made to complete data collection.



Data was analyzed through the business intelligent report for patients seen in office for a follow-up visit with E&M codes 99213, 9914, 99215 who were prescribed an overactive bladder medication from December 2022 through February 2023.



A root cause analysis was completed to determine why medications were too costly. An intervention was designed and implemented. Investigator created a written document in November 2022 to help guide patients with navigating cost of their prescriptions. This document was embedded into established clinic workflow through after visit summary documentation in Epic, electronic health record.

Results: 155 patients were seen initially and 48 patients (30.9%) returned for follow-up visit. 19 (39.5%) of these patients remained on their preferred overactive bladder medication at follow-up visit. 60.5% of patients who returned for an office visit did not remain on their preferred OAB medication.

Following intervention, results showed increase in patients taking preferred OAB medication at time of follow-up visit from baseline 39.5% to 48% (29/60).

Conclusions: In conclusion, our patients had an increased access and adherence rate for preferred overactive bladder medication after an intervention focusing on patient awareness of cost-navigation strategies. This practice continues to utilize prescription navigation handout. As increasing trends move toward utilizing non-pharmacologics as initial advanced therapies, further work is anticipated to assess patient access rates to traditionally 3^rd line interventions.