Center for Health Economics and Science Policy, United BioSource Corporation, 430 Bedford Street, Suite 300, Lexington, MA, 02420, USA,
Int Urol Nephrol. 2014 Jan;46(1):285-96. doi: 10.1007/s11255-013-0507-y. Epub 2013 Aug 14.
To assess appropriateness of antimuscarinic use in long-term care facilities (LTCFs) among treated and untreated urinary incontinence (UI) residents from 2007 to 2009.
We conducted a retrospective analysis using the AnalytiCare(SM) database consisting of minimum data sets (MDS) assessments and prescription records of 90,660 residents from 2007 to 2009. UI (MDS H1b ≥ 1) residents with ≥ 14-day LTCF stay were identified and categorized as treated if they had ≥ 1 antimuscarinic prescription and untreated if they had no antimuscarinics. A random sample of untreated residents was matched based on treated residents' type of MDS assessment. We defined appropriate antimuscarinic use if residents had adequate cognitive function [≤ 4 on the cognitive performance scale (0 = intact to 6 = very severe impairment)] and mobility [scoring <4 on mobility for toileting scale (MDS item G1iA 0 = independent to 4 = total dependent)]. Chi-square tests were used to detect statistical difference between cohorts.
A total of 5,327 residents (2,840 treated; 2,487 untreated) were selected [mean age (standard deviation) 80 (8), 81 (8) years; female (76, 65 %), respectively]. On study-defined MDS assessment, 63 % of treated and 69 % of untreated residents had UI (P < 0.01). Approximately 84 % of treated and 74 % of untreated residents may have had cognitive function and mobility sufficient for appropriate antimuscarinic use (P < 0.01).
Our study identified a high percentage of LTCF residents with UI who may have been candidates for antimuscarinics. However, due to the MDS limitation, we were unable to identify overactive bladder patients among these untreated residents with UI. It is possible that untreated control residents had UI due to other factors not amenable to treatment with antimuscarinic agents. Therefore, choice of treatment for each resident needs to be individualized and carefully monitored for efficacy and adverse effects. This retrospective analysis requires prospective confirmation. Proper patient selection for antimuscarinic treatment requires careful assessment of underlying physical status including cognitive function, mobility, and comorbidities.
评估 2007 年至 2009 年治疗和未治疗的尿失禁（UI）长期护理机构（LTCF）居民中使用抗毒蕈碱药物的适宜性。
我们使用 AnalytiCare（SM）数据库进行了回顾性分析，该数据库由 2007 年至 2009 年的最小数据集（MDS）评估和处方记录组成。确定了至少有 14 天 LTCF 入住的具有 UI（MDS H1b≥1）的居民，并根据他们是否有≥1 种抗毒蕈碱药物处方将其归类为治疗组，如果他们没有抗毒蕈碱药物，则归类为未治疗组。根据治疗组 MDS 评估的类型，对未治疗的居民进行随机抽样匹配。如果居民有足够的认知功能[认知功能量表（CPS）≤4（0=完整至 6=严重受损）]和活动能力[如厕活动量表（MDS 项目 G1iA）评分<4（0=独立至 4=完全依赖）]，则定义为合理使用抗毒蕈碱药物。卡方检验用于检测队列之间的统计学差异。
共选择了 5327 名居民（2840 名治疗组；2487 名未治疗组）[平均年龄（标准差）为 80（8）、81（8）岁；女性（76%、65%）]。根据研究定义的 MDS 评估，63%的治疗组和 69%的未治疗组居民有 UI（P<0.01）。大约 84%的治疗组和 74%的未治疗组居民可能有足够的认知功能和活动能力，适合使用抗毒蕈碱药物（P<0.01）。
我们的研究发现，有相当一部分患有 UI 的 LTCF 居民可能是抗毒蕈碱药物的候选者。然而，由于 MDS 的局限性，我们无法确定这些患有 UI 的未治疗对照组居民中是否存在逼尿肌过度活动症患者。可能未接受治疗的对照组居民患有 UI 是由于其他无法用抗毒蕈碱药物治疗的因素所致。因此，每位居民的治疗选择需要个体化，并仔细监测疗效和不良反应。本回顾性分析需要前瞻性确认。抗毒蕈碱治疗的正确患者选择需要仔细评估潜在的身体状况，包括认知功能、活动能力和合并症。
