Urinary Incontinence Medications: Patient-Initiated Concerns in Primary Care.

Area of Science:

• Urology
• Pharmacology
• Health Services Research

Background:

• Overactive bladder (OAB) and urge urinary incontinence (UUI) are prevalent conditions impacting quality of life.
• Guideline-recommended medications offer efficacy but are associated with significant costs and potential side effects.
• Patient perspectives on OAB/UUI pharmacotherapy in primary care settings remain underexplored.

Purpose of the Study:

• To characterize primary care provider (PCP)-patient interactions concerning OAB/UUI medications.
• To identify the types of clinical concerns, cost, and authorization issues discussed.
• To examine the communication modalities for these discussions.

Main Methods:

• Retrospective cohort study of women aged 18-89 prescribed OAB/UUI medication between 2017-2018.
• Electronic health record review for prior authorization requests and patient-reported concerns (cost, side effects, ineffectiveness) over 15 months.
• Logistic regression analysis to assess associations between patient demographics, comorbidity, medication class, and reported concerns.

Main Results:

• 46.2% of patients reported at least one OAB/UUI medication concern, with many reported outside of office visits.
• Higher comorbidity was linked to a lower likelihood of any concern.
• Patients on long-acting antimuscarinics (non-oxybutynin) showed fewer side effect concerns but more cost concerns compared to short-acting antimuscarinics.

Conclusions:

• Patient concerns regarding OAB/UUI medications are frequent in primary care and often emerge outside of scheduled appointments.
• The nature of patient concerns (e.g., cost versus side effects) is influenced by the specific medication class prescribed.
• Understanding these varied concerns is crucial for optimizing OAB/UUI pharmacotherapy in primary care.