Factors associated with clinical assessment of overactive bladder and selection of treatment

• Published in: Clinical therapeutics 2001-09, Vol.23 (9), p.1542-1551
• Main Authors: Diokno, Ananais, Lee, Paul, Zorn, Burkhardt Henry, Lenderking, William R., Grossman, Michael A., Bull, Scott A., Albrecht, Detlef
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; overactive bladder; Practice Patterns, Physicians; treatment selection; urge urinary incontinence; Urinary Incontinence - diagnosis; Urinary Incontinence - therapy; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/S0149-2918(01)80126-0

Background: Overactive bladder (OAB) affects > 17 million individuals in the United States, but the symptoms of OAB are frequently underreported by patients and therefore untreated by physicians. Objective: The purpose of this observational study was to investigate the demographic and clinical factors associated with the decision to treat OAB pharmacologically and identify factors associated with physicians' assessment of symptom severity. Methods: We studied 31 physicians treating 217 patients with OAB and collected data on patient demographic characteristics, OAB symptoms, previous management strategies, physicians' assessments of OAB severity, and treatment prescribed. Stepwise logistic regression was used to identify factors associated with selecting pharmacologic treatment and with physician assessment of severity of OAB symptoms. Results: The mean age of the patients was 61.3 years; ∼82% were female, and ∼73% were white. Participants with urinary incontinence were significantly ( P < 0.001) more likely to be treated with medication than were those with only symptoms of nocturia or urinary frequency. Other significant factors associated with pharmacologic treatment were being white (odds ratio [OR], 9.5; 95% CI, 2.9–30.8); being black (OR, 5.9; 95% CI, 1.2–29.7); physician's clinical assessment of OAB as moderate (OR, 3.5; 95% CI, 1.5–8.2) or severe (OR, 3.8; 95% CI, 1.1–13.7); previous use of medication (OR, 2.9; 95% CI, 1.1–8.1); and number of incontinence episodes in the last 24 hours (OR, 1.2; 95% CI, 1.0–1.5). Factors associated with physician assessment of OAB severity included distress due to OAB symptoms (OR, 2.1; 95% CI, 1.3–3.2), number of incontinence episodes in the last 24 hours (OR, 1.2; 95% CI, 1.1–1.4), and use of previous treatment(s) (OR, 0.4; 95% CI, 0.2–0.8). Conclusions: Both demographic and clinical symptoms of OAB were associated with the decision to treat OAB with medication, whereas physicians' assessment of OAB severity was associated only with clinical symptoms. Urinary incontinence was the key symptom associated with the decision to treat patients with medication and with the assessment of OAB symptom severity.