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

Abstract

Importance Implementation of an overactive bladder (OAB) care pathway may affect treatment patterns and progression. Objectives This study aimed to assess the effect of OAB care pathway implementation on treatment patterns for women with OAB. Study Design This retrospective cohort study evaluated women with OAB, before (January 1, 2015–December 31, 2017) and after (January 1, 2019–December 31, 2021) care pathway initiation. Care pathway use included standardized counseling, early introduction of therapy, and close follow-up. Primary outcomes included OAB medication use, follow-up visits, third-line therapy, and time to third-line therapy. Results A total of 1,349 women were included: 1,194 before care pathway implementation and 155 after. Patients after implementation were more likely to have diabetes mellitus (P = 0.04) and less likely to smoke (P = 0.01). Those managed via a care pathway were more likely to use any medication or third-line therapy within 1 year after consultation (61.3% vs 25.0%; P < 0.001). This included higher proportions receiving a medication (50.3% [95% confidence interval (CI), 41.8%–57.6%] vs 23.3% [95% CI, 20.9%–25.7%]; P < 0.001) and progressing to third-line therapy (22.6% [95% CI, 15.7%–28.9%] vs 2.9% [95% CI, 2%–3.9%]; P < 0.001). Among those who underwent third-line treatment, care pathway use was associated with shorter time to third-line therapy (median, 10 days [interquartile range, 1–56 days] vs 29 days [interquartile range, 7–191 days]; P = 0.013). Those managed via a care pathway were less likely to have additional clinic visits for OAB within 1 year after initial consultation (12.3% vs 23.9%; P < 0.001). Conclusions Use of an OAB care pathway was associated with higher rates of oral medication and third-line therapy yet decreased follow-up office visits. Use of an OAB care pathway may promote consistent and efficient care for women with OAB.