University of Texas Health Sciences Center, San Antonio, TX, USA.
Analysis Group, Inc., Boston, MA, USA.
J Int Med Res. 2022 May;50(5):3000605221098176. doi: 10.1177/03000605221098176.
To understand factors guiding overactive bladder (OAB) therapy selection and experience with combination therapy (antimuscarinics and beta-3 agonists).
Cross-sectional surveys of OAB patients and OAB-treating physicians in the USA were conducted. Patients receiving monotherapy with antimuscarinics were categorized by OAB treatment history: monotherapy only; third-line procedures (e.g., onabotulinumtoxinA injections) and combination therapy; third-line therapy only; and combination therapy only. The patient survey assessed therapy choice drivers and barriers, treatment satisfaction and sociodemographic/clinical characteristics. The physician survey assessed drivers of and barriers to OAB treatment choices.
Of 200 patients, 86.5% reported involvement in treatment decision-making; doctor's recommendation was the most frequently considered factor (84.4%). Most patients (71%) were unaware of combination therapy. The primary reason why those patients aware of combination therapy had not used it (N = 43/200; 21%) was physician recommendation of other treatments (69.8%). For physicians (N = 50), the most frequently considered factors when prescribing OAB treatment were effectiveness (92.0%) and side effects (84.0%); 70% prescribed combination therapy, primarily for symptom severity (82.9%). The main reasons for not prescribing combination therapy were cost/insurance coverage (80%) and lack of information (53.3%).
Shared decision-making guided treatment decisions; the main considerations were treatment safety and efficacy.
了解指导膀胱过度活动症（OAB）治疗选择的因素和联合治疗（抗毒蕈碱药物和β3 激动剂）的经验。
对美国的 OAB 患者和 OAB 治疗医生进行了横断面调查。接受抗毒蕈碱药物单药治疗的患者根据 OAB 治疗史进行分类：单药治疗；三线治疗（如肉毒杆菌毒素 A 注射）和联合治疗；三线治疗仅；联合治疗仅。患者调查评估了治疗选择的驱动因素和障碍、治疗满意度以及社会人口学/临床特征。医生调查评估了 OAB 治疗选择的驱动因素和障碍。
在 200 名患者中，86.5%报告参与了治疗决策；医生的建议是最常考虑的因素（84.4%）。大多数患者（71%）不知道联合治疗。那些知道联合治疗但没有使用它的患者（N=200 中的 43 人；21%）的主要原因是医生推荐了其他治疗方法（69.8%）。对于医生（N=50），开具 OAB 治疗处方时最常考虑的因素是有效性（92.0%）和副作用（84.0%）；70%的医生开具联合治疗处方，主要是因为症状严重程度（82.9%）。不开具联合治疗处方的主要原因是成本/保险覆盖（80%）和缺乏信息（53.3%）。
共同决策指导治疗决策；主要考虑因素是治疗安全性和疗效。
