Elliott Christopher S, Dallas Kai, Shem Kazuko, Crew James
Department of Urology, Stanford University Medical Center.
Division of Urology, Santa Clara Valley Medical Center.
J Urol. 2022 Nov;208(5):1055-1074. doi: 10.1097/JU.0000000000002836. Epub 2022 Jun 24.
In April 2008, Medicare amended its policy for clean intermittent catheterization, increasing coverage from 4 reused catheters per month to up to 200 single-use catheters. The primary reason for the policy change was an assumed decrease in risk of urinary tract infection with single-use catheters. Given its economic/environmental impact (∼50-fold increase in cost and plastic waste) and a paucity of supporting evidence, we retrospectively evaluate the policy's effect in a prospective spinal cord injury registry.
We accessed data for the years 1995 to 2020 from the National Spinal Cord Injury Database focusing on 1-year follow-up in those unable to volitionally void after injury. We asked 2 questions: (1) Did hospitalizations for genitourinary reasons decrease after the clean intermittent catheterization policy change?; and (2) Did clean intermittent catheterization adoption and adherence increase after the clean intermittent catheterization policy change?
During the study period, 2,657 of the 6,843 (38.8%) participants unable to volitionally void after spinal cord injury were hospitalized during their first follow-up year. Of the cohort performing clean intermittent catheterization, fewer individuals were hospitalized for genitourinary reasons prior to the clean intermittent catheterization policy change compared to after (10.6% vs 14.6%, < .001), a finding that persisted on multivariate logistic regression (odds radio, 0.67, < .001). In addition, the number of individuals performing clean intermittent catheterization at 1-year follow-up was less after the policy change compared to prior (57.0% vs 59.1%, = .044).
Our findings suggest the 2008 policy change shifting clean intermittent catheterization coverage from catheter reuse to single-use did not decrease hospitalizations for urinary tract infection or increase clean intermittent catheterization uptake in individuals with spinal cord injury.
2008年4月，医疗保险修改了其清洁间歇性导尿政策，将覆盖范围从每月4根重复使用的导管增加到多达200根一次性使用的导管。政策变更的主要原因是假定一次性使用导管可降低尿路感染风险。鉴于其经济/环境影响（成本和塑料废物增加约50倍）以及缺乏支持证据，我们在一个前瞻性脊髓损伤登记处对该政策的效果进行了回顾性评估。
我们从国家脊髓损伤数据库获取了1995年至2020年的数据，重点关注受伤后无法自主排尿者的1年随访情况。我们提出了两个问题：（1）清洁间歇性导尿政策变更后，因泌尿生殖系统原因住院的情况是否减少？（2）清洁间歇性导尿政策变更后，清洁间歇性导尿的采用率和依从性是否提高？
在研究期间，6843名脊髓损伤后无法自主排尿的参与者中，有2657人（38.8%）在首次随访年度住院。在进行清洁间歇性导尿的队列中，与政策变更后相比，清洁间歇性导尿政策变更前因泌尿生殖系统原因住院的个体较少（10.6%对14.6%，P<0.001），这一发现经多因素逻辑回归后仍然存在（比值比，0.67，P<0.001）。此外，与政策变更前相比，政策变更后1年随访时进行清洁间歇性导尿的个体数量减少（57.0%对59.1%，P=0.044）。
我们的研究结果表明，2008年将清洁间歇性导尿覆盖范围从导管重复使用改为一次性使用的政策变更，并未降低脊髓损伤患者因尿路感染的住院率，也未提高清洁间歇性导尿的使用率。
