Department of Obstetrics & Gynecology, Loyola University, Chicago, IL, USA.
BJU Int. 2010 May;105(9):1283-90. doi: 10.1111/j.1464-410X.2009.09035.x. Epub 2009 Nov 12.
To identify predictors of self-reported discontinuation of overactive bladder (OAB) medication using a three-phase survey.
In January 2005, a phase 1 survey was sent to 260 000 households in the USA to assess the prevalence of OAB symptom bother, treatment patterns and healthcare consulting behaviour. In July 2005, a detailed phase 2 follow-up survey was sent to 6577 phase 1 respondents who had used one or more OAB medications within the 12 months before phase 1; the phase 2 survey included questions about respondents' sociodemographic characteristics, general health status, OAB symptom bother, healthcare consulting behaviour, beliefs about OAB and treatment options, and medication usage. Six months later, a phase 3 survey was sent to 3387 phase-2 respondents who were persistent with OAB medication or had discontinued within <18 months of phase 2; the phase 3 survey measured the same variables as phase 2. Only phase 3 respondents who were persistent with OAB medication at phase 2 were included in the analyses reported here. Assessed were the proportions of respondents who were still persistent with OAB medication at phase 3 and who discontinued OAB medication between phases 2 and 3. The variables measured during the phase 2 survey were screened as potential predictors of discontinuation at phase 3 using univariate analysis and then assessed using multivariate logistic regression.
Among 2838 respondents at phase 3 (84% response rate), 1194 had recently discontinued and 1644 were persistent with medication at phase 2. Among phase-3 respondents who were persistent at phase 2, 1040 (66%) continued to be persistent at phase 3, 280 (18%) had discontinued between phases 2 and 3, and 261 (17%) had switched medication between phases 2 and 3; 63 respondents had missing prescription information at phase 3. Predictors of discontinuing at phase 3 included smoking (odds ratio 1.80; 95% confidence interval 1.15-2.83; P = 0.010), not knowing whether treating bladder problems requires multiple daily doses of medication (1.71, 1.10-2.67; P = 0.018), believing (2.11, 1.34-3.33; P = 0.001) or not knowing (1.76, 1.23-2.52; P = 0.002) whether adverse effects of OAB medications are often severe, and being bothered 'quite a bit or more' by a sudden urge to urinate (1.54, 1.05-2.26; P = 0.028). Respondents taking two or more medications were less likely to discontinue (odds ratio 0.45-0.58; P < 0.05).
Persistence with OAB medications might be improved by addressing predictors of discontinuation in the management of OAB, by proactively informing patients about the severity of antimuscarinic adverse effects, and dosing regimens. Bother associated with the key OAB symptom, urgency, is a predictor of discontinuation of treatment.
通过三阶段调查，确定报告中与自主停止治疗膀胱过度活动症（OAB）相关的预测因素。
2005 年 1 月，对美国 26 万户家庭进行了第 1 阶段的调查，评估 OAB 症状困扰、治疗模式和医疗保健咨询行为的流行率。2005 年 7 月，向在第 1 阶段前 12 个月内使用过一种或多种 OAB 药物的 6577 名第 1 阶段应答者发送了详细的第 2 阶段随访调查；第 2 阶段调查包括应答者的社会人口统计学特征、一般健康状况、OAB 症状困扰、医疗保健咨询行为、对 OAB 和治疗选择的看法以及药物使用情况。6 个月后，向 3387 名在第 2 阶段持续使用 OAB 药物或在第 2 阶段后 18 个月内停药的第 2 阶段应答者发送了第 3 阶段调查；第 3 阶段调查测量了与第 2 阶段相同的变量。只有在第 2 阶段持续使用 OAB 药物的第 3 阶段应答者才包括在本报告的分析中。评估了在第 3 阶段仍持续使用 OAB 药物的应答者的比例，以及在第 2 阶段和第 3 阶段之间停止 OAB 药物治疗的比例。第 2 阶段调查中测量的变量使用单变量分析作为第 3 阶段停药的潜在预测因素进行筛选，然后使用多变量逻辑回归进行评估。
在第 3 阶段的 2838 名应答者中（84%的应答率），1194 名最近停药，1644 名在第 2 阶段持续使用药物。在第 2 阶段持续使用药物的第 3 阶段应答者中，1040 名（66%）在第 3 阶段继续持续使用，280 名（18%）在第 2 阶段和第 3 阶段之间停药，261 名（17%）在第 2 阶段和第 3 阶段之间更换药物；63 名应答者在第 3 阶段的处方信息缺失。第 3 阶段停药的预测因素包括吸烟（优势比 1.80；95%置信区间 1.15-2.83；P = 0.010）、不知道治疗膀胱问题是否需要每日多次剂量的药物（1.71，1.10-2.67；P = 0.018）、相信（2.11，1.34-3.33；P = 0.001）或不知道（1.76，1.23-2.52；P = 0.002）OAB 药物的不良反应是否经常严重，以及经常因突然有尿意而感到“相当困扰或更困扰”（1.54，1.05-2.26；P = 0.028）。服用两种或两种以上药物的患者不太可能停药（优势比 0.45-0.58；P < 0.05）。
通过在 OAB 管理中解决停药的预测因素，积极告知患者抗毒蕈碱不良反应的严重程度和给药方案，可能会提高 OAB 药物的治疗依从性。与关键 OAB 症状尿急相关的困扰是治疗停药的预测因素。
