Boone Timothy B, Kusek John W, Nyberg Leroy M, Steele Graeme, Pashos Chris, Grossman Michael, Diokno Ananias, Bull Scott, Albrecht Detlef
Baylor College of Medicine, Houston, Texas 77030, USA.
Clin Ther. 2002 Mar;24(3):397-408. doi: 10.1016/s0149-2918(02)85041-x.
Several pharmacologic and nonpharmacologic interventions are available for the treatment of symptoms of overactive bladder (OAB). The relationship between type of initial intervention and subsequent symptom improvement and resource utilization has not been explored in detail.
The purpose of this study was to assess (1) the proportion of patients continuing with their initially prescribed treatment for OAB 3 and 6 months after the initial evaluation and (2) the relationship between actual treatment patterns, symptom improvement. and number of physician office visits.
A total of 31 physicians enrolled patients with OAB for this 6-month prospective, observational study. Baseline data on OAB symptom severity and OAB management strategies were obtained and initial treatment(s) were prescribed by physicians during a routine office visit. Follow-up data on symptom changes, treatment changes, number of physician office visits, and the frequency of absorbent pad use were collected via telephone interviews with patients 3 and 6 months after the initial visit. Stepwise logistic regression was used to assess the relationship between patient characteristics, prescription of medication, and symptom improvement.
A total of 213 patients were enrolled; 122 (57.3%) and 100 (46.9%) patients provided follow-up data at the 3-month and 6-month assessments, respectively. The mean age was 61.2 years; 85.2% of patients were female, and 77.7% were white. OAB symptom improvement was significantly related to being prescribed medication (odds ratio [OR], 4.3; 95% CI, 1.8-9.9) and the mean number of daily leakage incidents at baseline (OR, 3.2; 95% CI, 1.2-8.4). Although patients who were prescribed drugs at baseline tended to have fewer physician office visits and were less likely to be prescribed nondrug interventions than patients who were not treated initially with drugs, these differences were not statistically significant.
Pharmacologic treatment for symptoms of OAB appears to be associated with greater symptom improvement than nonpharmacologic treatment. Larger studies of experimental design are needed to determine whether patients treated with medication use fewer nondrug interventions and require fewer physician office visits than patients treated without medication.
有多种药物和非药物干预措施可用于治疗膀胱过度活动症（OAB）的症状。初始干预类型与后续症状改善及资源利用之间的关系尚未得到详细探讨。
本研究的目的是评估（1）在初始评估后3个月和6个月继续接受最初开具的OAB治疗的患者比例，以及（2）实际治疗模式、症状改善与医生门诊就诊次数之间的关系。
共有31名医生招募了OAB患者参与这项为期6个月的前瞻性观察研究。获取了OAB症状严重程度和OAB管理策略的基线数据，并由医生在常规门诊就诊时开具初始治疗方案。在初次就诊后3个月和6个月，通过电话访谈患者收集症状变化、治疗变化、医生门诊就诊次数以及使用吸收性尿垫频率的随访数据。采用逐步逻辑回归分析评估患者特征、药物处方与症状改善之间的关系。
共纳入213例患者；分别有122例（57.3%）和100例（46.9%）患者在3个月和6个月评估时提供了随访数据。平均年龄为61.2岁；85.2%的患者为女性，77.7%为白人。OAB症状改善与开具药物治疗（优势比[OR]，4.3；95%置信区间[CI]，1.8 - 9.9）以及基线时每日漏尿事件的平均次数（OR，3.2；95% CI，1.2 - 8.4）显著相关。尽管与最初未接受药物治疗的患者相比，基线时开具药物治疗的患者门诊就诊次数往往较少，且接受非药物干预的可能性较小，但这些差异无统计学意义。
与非药物治疗相比，药物治疗OAB症状似乎能带来更大程度的症状改善。需要开展更大规模的实验设计研究，以确定接受药物治疗的患者与未接受药物治疗的患者相比，是否使用更少的非药物干预措施且需要更少的医生门诊就诊次数。
