The Impact of Overactive Bladder Care Pathway Implementation on Longitudinal Patient Management

Objectives: Overactive bladder (OAB) is a common and debilitating disorder that is often underrecognized and undertreated. Typically, treatment progresses from conservative measures, such as behavioral therapies or oral medications, to procedural interventions when needed. Side effects and limited efficacy are known issues with the available oral medications. However, historically few patients progress beyond these measures. Our primary objective was to assess the impact of OAB care pathway implementation in a Female Pelvic Medicine and Reconstructive Surgery (FPMRS) trained practice on treatment patterns for women with OAB.

Methods: We retrospectively searched our electronic health record for women treated with OAB in our FPMRS practice from 1/1/2015-12/31/2017 and 1/1/2019-12/31/2021. Care pathway use included standardized counseling, early introduction of all lines of therapy, and follow-up telephone/portal touchpoints. Women were stratified into cohorts, before and after care pathway implementation for comparison. A 6 month wash out period was included before and after pathway initiation (7/2018). Patient outcomes included OAB medication use, follow-up visits, third line therapy use, and time to third line therapy. Cohorts were compared using Kruskal-Wallace tests for continuous variables and Chi-square test for categorical variables. Sensitivity analysis was performed excluding patients with treatments within 2 years prior to the first OAB consult with our practice.

Results: A total of 1235 women were included, 1080 prior to care pathway implementation and 155 after. The cohorts were similar regarding age (p=0.38) and distance travelled for care (p=0.27), though those treated after pathway implementation were more likely to have OAB medication treatment within 2 years prior to the first consult in our practice (37.4% vs 15.5%;p < 0.001). Those managed with a care pathway were more likely to have any medication or third line therapy use within 1 year after consultation (61.3% vs 24.4%;p < 0.001). Patients managed with a care pathway were prescribed a higher number of medications within 1 year of the consultation (median 1 [IQR 0-1] vs 0 [0-0];p < 0.001) and were more likely to progress to third line therapy (22.6% vs 2.7%;p < 0.001). Among those who underwent third line treatment, use of a care pathway was associated with a shorter time to third line therapy (median 10 days [IQR 1-56] vs 35 days [7-191];p=0.02). Those managed via a care pathway were less likely to have additional visits for OAB following initial consultation (12.3% vs 22.9%;p=0.003). Similar results were identified on sensitivity analysis limiting to patients with no medication use within 2 years prior to initial consultation in the cohorts.

Conclusions: Use of a care pathway increases initiation of medication and progression to third line therapy in an academic FPMRS practice. Our data suggest that care pathway use presents an opportunity to facilitate patient care for those with OAB.