Presentation Authors: Chris Du, William Berg*, Zhenyue Huang, Anh Nguyen, Alice Cheung, Alexandra Siegal, Colin Dabrowski, Sina Mehraban-Far, Steven Weissbart, Jason Kim, Stony Brook, NY
Introduction: Anecdotally, patients with overactive bladder (OAB) have poor follow-up and few patients progress to third line therapies. The American Urological Association (AUA) developed a clinical care pathway (CCP) to improve OAB care. We sought to quantify and determine how often new OAB patients follow up and utilize third line therapy before and after the implementation of the CCP.
Methods: Our institution approved OAB database was queried for only new OAB patient visits. These patients were followed longitudinally over 12 months to determine rates of follow-up and utilization of third line therapies. New patients were divided into three distinct time periods: pre-CCP 2014-2015, post-CCP 2016, and post-CCP January 2017-June 2017. Outcomes were compared amongst groups. Our analysis encompassed 9 subspecialty trained urologists, including 1 FPRMS certified urologist.
Results: A total of 1,114 new OAB patients were identified. There were 507, 430, and 176 patients in the pre-CCP, 2016 CCP, and 2017 CCP groups, respectively. After CCP implementation, follow-up rates significantly increased at 3, 6, and 12 months (Table 1). Mean follow-up visits at 6 months and at 12 months increased significantly from pre-CCP to 2 years post-CCP (0.88-1.6, p < 0.01 and 1.21-2.06, p < 0.01, respectively). Additionally, the third line therapy utilization at 6 months increased from 4.7% pre-CCP to 10% two years post-CCP (p=0.02). In particular, percutaneous tibial nerve stimulation numbers significantly from 0.8% to 5.7% (p < 0.01) at 6 months and 2.2% to 6.3% (p=0.03) at 12 months. The median days to third line therapy decreased from 199 to 85 (p < 0.01). Specifically, the FPMRS provider had an increase in third line therapy utilization at 6 months from 8.1% pre-CCP to 16.4% two years post-CCP (p=0.054) and 12 month of 11.5% pre-CCP to 20.2% two years post-CCP (p=0.08). Within 1 year, patients also went on to a second third line therapy more frequently (0% vs. 3.1% and 1.9%, p=0.02).
Conclusions: This study demonstrates that after CCP implementation, new patients more reliably follow-up and follow-up quicker. Additionally, refractory patients progress quicker to third line therapies. Despite these findings, 35% of new OAB patients fail to follow-up within one year and utilization of third line therapies remains low.