Overactive bladder (OAB) is highly prevalent and has a negative impact on quality of life. Follow up and compliance rates are traditionally poor in this patient population, with many patients cycling between multiple medications without improvement or progression to 3rd line therapies. We sought to improve our practice follow-up rate and utilization of 3rd line therapies with the introduction of OAB care pathway.

Our study cohort included all new OAB patients from 1 year prior to 1 year after the introduction of an OAB care pathway in January 2016. Patients were identified by the diagnosis of OAB, urinary frequency, urgency, and urgency incontinence. Follow up dates and utilization of therapies were compared pre and post introduction of the OAB care pathway. 11 subspecialty trained urologists, including 1 FPRMS certified urologist were included in the analysis.

A total of 1343 patients were identified. 726 patients were in the pre-pathway cohort and 617 in post-pathway cohort. The follow-up rate at 6 weeks for new OAB patients was significantly higher after clinical pathway introduction (30.4% vs 37.1% p=0.01). Additionally, 3 month follow-up rate was significantly higher after introduction (40.1% vs 50.9% p<0.01). The FPMRS trained attending in our practice had similarly improved follow up rates at 6 weeks (22% vs 32% p<0.01) and 3 months (35% vs 47% p<0.01). For both the entire practice and the FPMRS provider, the mean number of visits in 6 months increased over 50% after introduction of the pathway (0.81 vs 1.23 P<0.01 and 0.91 vs 1.48 p<0.01 respectively). In a 6 month follow up period, utilization of 3rd line therapies increased significantly from 2.9% to 5.5% (p=0.02). Furthermore, for the FPRMS provider, utilization for 3rd line therapies in 6 months increased from 6.3% to 12% (p=0.02).

The integration of a clinical care pathway significantly increased the patient follow up rate,. Additionally, there was a significant increase in the utilization of 3rd line therapies within 6 months of initial visit. These increases are especially notable in the FPMRS-trained urologist cohort, where utilization of third line therapies nearly doubled from 6.3% to 12%.

The integration of a clinical care pathway has resulted in OAB patients returning more often and with increased use of third line therapies. Further studies may elucidate whether the OAB care pathway will lead to increased patient quality of life and satisfaction.