Kimia Menhaji1, Olivia O Cardenas-Trowers2, Olivia H Chang3, Evelyn F Hall4, Nancy E Ringel5, Kerac N Falk6. 1. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 2. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Women's Health, University of Louisville School of Medicine, Louisville, KY, USA. 3. Center for Urogynecology and Pelvic Reconstructive Surgery, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA. 4. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Women & Infants Hospital of Brown University, Providence, RI, USA. 5. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC, USA. 6. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, 1365-A Clifton Road, 4th Floor, Atlanta, GA, 30322, USA. kerac.falk@emory.edu.
Abstract
INTRODUCTION AND HYPOTHESIS: Recent publications show an association between exposure to anticholinergic medications and the risk of developing dementia. We hypothesized that urogynecology providers have changed their overactive bladder syndrome treatment as a result of this literature. METHODS: This was an anonymous, cross-sectional, web-based survey of American Urogynecologic Society members. Survey questions queried awareness of the referenced literature, prescribing practices, the impact of insurance on treatment plans, and demographics. Our primary outcome measured the change in prescribing practice in response to literature linking anticholinergic medications with the risk of dementia. Descriptive statistics were used. RESULTS: A total of 222 urogynecology providers completed the survey. Nearly all respondents (99.1%) were aware of the recent literature, and, as a result, 90.5% reported changing their practice. Prior to the publication of recent literature, a "non-CNS-sparing" anticholinergic (e.g., oxybutynin) was most commonly prescribed (64.4%), whereas after the literature was published, this shifted to ß3-adrenoceptor agonists (58.5%, p < 0.001). A majority of respondents (96.6%) reported that insurance restrictions led to a change in treatment for some patients, with 73.5% describing the prior-authorization process as difficult. Many providers (61.8%) reported that a trial of anticholinergics was required by insurance companies prior to authorizing mirabegron. CONCLUSIONS: The recent literature associating anticholinergic medications with the development of dementia has changed practice patterns among survey respondents, with a shift away from anticholinergic medications and toward ß3-adrenoceptor agonists. The majority of respondents report insurance barriers to non-anticholinergic therapies, resulting in alteration of their preferred practices.
INTRODUCTION AND HYPOTHESIS: Recent publications show an association between exposure to anticholinergic medications and the risk of developing dementia. We hypothesized that urogynecology providers have changed their overactive bladder syndrome treatment as a result of this literature. METHODS: This was an anonymous, cross-sectional, web-based survey of American Urogynecologic Society members. Survey questions queried awareness of the referenced literature, prescribing practices, the impact of insurance on treatment plans, and demographics. Our primary outcome measured the change in prescribing practice in response to literature linking anticholinergic medications with the risk of dementia. Descriptive statistics were used. RESULTS: A total of 222 urogynecology providers completed the survey. Nearly all respondents (99.1%) were aware of the recent literature, and, as a result, 90.5% reported changing their practice. Prior to the publication of recent literature, a "non-CNS-sparing" anticholinergic (e.g., oxybutynin) was most commonly prescribed (64.4%), whereas after the literature was published, this shifted to ß3-adrenoceptor agonists (58.5%, p < 0.001). A majority of respondents (96.6%) reported that insurance restrictions led to a change in treatment for some patients, with 73.5% describing the prior-authorization process as difficult. Many providers (61.8%) reported that a trial of anticholinergics was required by insurance companies prior to authorizing mirabegron. CONCLUSIONS: The recent literature associating anticholinergic medications with the development of dementia has changed practice patterns among survey respondents, with a shift away from anticholinergic medications and toward ß3-adrenoceptor agonists. The majority of respondents report insurance barriers to non-anticholinergic therapies, resulting in alteration of their preferred practices.
Authors: Ibrahim M Abbass; Eleanor O Caplan; Daniel B Ng; Rita Kristy; Carol R Schermer; Pamela Bradt; Jenna M Collins; Wai Man Maria Chan; Brandon T Suehs Journal: J Manag Care Spec Pharm Date: 2017-01
Authors: Noll Campbell; Malaz Boustani; Tony Limbil; Carol Ott; Chris Fox; Ian Maidment; Cathy C Schubert; Stephanie Munger; Donna Fick; David Miller; Rajesh Gulati Journal: Clin Interv Aging Date: 2009-06-09 Impact factor: 4.458