Barriers and facilitators to overactive bladder therapy adherence

Abstract

Aims: To provide an overview of the barriers and facilitators to overactive bladder (OAB) therapy initiation and adherence.

Methods: A PubMed and Embase literature search was conducted to identify barriers to OAB therapy adherence.

Results: OAB therapy adherence is associated with improvements in urinary symptoms, and quality of life with reductions in annual costs for OAB-related expenditures. However, adherence rates to behavioral therapies are as low as 32% at 1 year, only 15%-40% of treated patients remain on oral medications at 1 year due to several factors (e.g., inadequate efficacy, tolerability, and cost), and 5%-10% of OAB patients progress to advanced therapies. While some common barriers to therapy adherence are often fixed (e.g., costs, lack of efficacy, time, side effects, treatment fatigue), many are modifiable (e.g., lack of knowledge, poor relationships, negative experiences, poor communication with providers). Patient-centered care may help address some modifiable barriers. Emerging data demonstrate that patient-centered care in the form of treatment navigators improves OAB therapy adherence and progression to advanced therapies in the appropriate patient.

Conclusions: There are numerous modifiable barriers to OAB therapy adherence. A patient-centered lens is needed to elicit patient goals, establish realistic treatment expectations, and tailor therapy to improve therapy adherence, optimize outcomes, and reduce healthcare expenditures. Further research is needed to develop and study low-cost, scalable solutions.

Keywords: behavioral therapy; overactive bladder; patient-centered care; pharmacotherapy; therapy adherence; third-line therapy; urinary incontinence.

FIGURE 1

Strategies for improving OAB therapy adherence: an adapted conceptual framework.^, BT, bladder training; PFMT, pelvic floor muscle training; QOL, quality of life; SDM, shared decision-making; SDOH, social determinants of health; SES, socioeconomic status.