Health Disparities in Access to Care for Overactive Bladder: Who Is Seen & Where

Objectives: To investigate if there are disparities in patient characteristics in medication treatment of OAB, referrals to subspecialists, and visits with a subspecialist at a tertiary academic center.

Methods: This was an observational study using the electronic medical record. A provider survey was conducted. The setting is a large tertiary academic center in an urban environment. The main hospital lies in a neighborhood on the South Side of Chicago, and the medical center includes several suburban locations. Female patients of any age who were seen by any primary care provider at any system site from January 1, 2015 through January 1, 2020 were included. In an effort to be inclusive, patients were included if they had an ICD 9 or 10 code related to overactive bladder, or if they were prescribed an OAB medication, or if they were referred to pelvic floor physical therapy. The primary outcome is patient referral to a subspecialist. Secondary outcomes included medication treatment for OAB and referral to pelvic floor physical therapy at the primary care level. We also explored reasons why primary care providers would or would not offer medication treatment for OAB or refer patients to see a subspecialist for OAB treatment.

Results: For patients presenting to their PCP with OAB symptoms and a diagnosis, 36.3% were treated with an OAB medication, mostly likely to be anticholinergic, and 6.2% of patients were referred to pelvic floor physical therapy. From their PCP, 23.2% of patients were referred to specialty care in OB/Gyn, urology, or urogynecology. Patients aged 50-65 and non-Hispanic White patients were more likely to be referred to a specialist than others. Of those patients who were referred, the majority (78.7%) went to the referral visit. And at the specialist, most patients received behavioral counseling and medication therapy, with few choosing third line OAB treatments.

Conclusions: Patients with OAB are treated with medications at the PCP level, and less likely to be referred for pelvic floor physical therapy, and fewer referred for specialty care. Non-Hispanic Black patients are less likely to be referred for specialty care. Future studies understanding barriers and facilitators to care by PCPs could promote increased treatment for patients with OAB.