WHY DO PATIENTS STOP MEDICATIONS FOR OVERACTIVE BLADDER?
IYER1, R. DARAPANENI 2, A. M. TRAN 3, C. BOTROS 4, S. LOZO 2, P. K. SAND 5, R. GOLDBERG 6, J. TOMEZSKO 1, A. GAFNI-KANE 6, S. BOTROS 7;
1NorthShore Univ. Hlth.Systems, Skokie, IL, 2Urogynecology, NorthShore Univ. Hlth.Systems, Skokie, IL, 3Univ. of Chicago, NorthShore Univ. Healt, Chicago, IL, 4Univ. of Chicago-Northshore Univ. Hlth., Skokie, IL, 5Univ. of Chicago, Winnetka, IL, 6NorthShore Univ. Hlth.System, Skokie, IL, 7Northshore Univ. Hlth.system, Chicago, IL.
Introduction: The mainstay of overactive bladder (OAB) treatment is the use of antimuscarinic medications. Previous studies have identified factors that are behind poor medication persistence, but few studies have investigated the role of insurance coverage, and correlation with OAB symptoms.
Objective: Our objective was to describe reasons for medication discontinuation, and to compare OAB symptoms with reasons underlying medication discontinuation.
Methods: We present a case series of 200 patients seen in a tertiary Urogynecology practice between 2002 and 2014 with a diagnosis of OAB. After data extraction from the electronic medical record using ICD9 codes, we conducted a chart review of a randomly selected sample of 200 patients all with complete data. Patients were followed over for the above time frame for at least 6 months after medication initiation with a total of 674 medication changes. Data collected included medication, dose and frequency of use, reason for discontinuation, use of behavioral and other OAB therapies, and OAB symptoms.
Results: The mean age of patients was 74 years old, with an average use of 2.9 medications per patient. On average patients had 9.8 urge incontinence episodes (UUI) per week, voided every 2.4 hours, and voided 2.2 times per night. 5% of patients had a neurologic diagnosis, and 23% had concomitant stress incontinence (SI). Patients were more likely prescribed solifenacin (23%) and oxybutynin ER (19.5%) above other medications. Patients discontinued OAB medication for lack of efficacy (49.6%), side effects (22.9%), cost/insurance reasons (9.9%), completion of treatment (8.5%), not reported (7.4%), and urinary retention (1.8%). The reason for discontinuation did not significantly change between each year of the study. Patients with greater number of UUI per week were significantly more likely to discontinue medication due to lack of efficacy over those with fewer UUI symptoms (p<0.0001).There was no difference seen in reasons for medication discontinuation for urinary urgency or nocturia.
Conclusions: Common reasons for medication discontinuation for OAB are lack of efficacy and side effects, while cost/ insurance reasons accounted for 10% of discontinuations. As UUI symptoms worsen, patients are more likely to discontinue medication.
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