According to an exploratory pilot study published in Menopause.
Overactive bladder is a common disorder that affects one in five women. This condition significantly affects the quality of life of women who are affected, but adherence to treatment is notoriously low. “Successful treatment for overactive bladder often requires both medication and behavioral modification, such as reducing the amount of fluids consumed and cutting down on beverages containing caffeine, a bladder irritant,” says the former. author Marcus Ortega, MD, a woman in pelvic medicine and reconstructive surgeon. at Massachusetts General Hospital (MGH). “Patients often stop medications due to side effects, and behavioral changes are not easy to make without positive reinforcement and objective proof of their effectiveness. We wanted to test whether we could improve treatment by keeping patients committed to care and accelerating treatment options.”
All 23 women enrolled in the pilot study had been re-diagnosed with overactive bladder during an in-person outpatient visit to the MGH. Instead of scheduling a traditional clinic follow-up visit for OAB at three months, however, the women received their first asynchronous visit approximately one month after their first office visit. The telehealth visit consisted of an electronic questionnaire from a clinician asking patients about their symptoms and treatment progress. Based on the patient’s responses, the clinician responded with specific recommendations. “For example, the clinician may recommend switching to another drug due to side effects or lack of efficacy, or reinforce certain behaviors to improve symptoms,” Ortega says. “Patient responses on validated medical questionnaires also allow us to objectively compare over time whether symptoms are improving, as it can be difficult for patients to track subjective symptoms month after month.”
Study participants completed a total of 50 online visits over an average of 135 days, with most women completing two telehealth visits. All study participants showed a statistically significant improvement in urinary symptoms and a decrease in the number of incontinence episodes between their first and last asynchronous visit. Women reduced their intake of fluids, including caffeinated and carbonated beverages, and more than 30% changed medications or had their dosage adjusted. Participants were highly satisfied with the experience, rating the asynchronous visits 8.8 on a 10-point satisfaction scale.
Despite recent advances in OAB therapies, nearly 50% of patients are frustrated with treatment results. Investigators attribute the improvement in participants’ urinary symptoms in this study to more frequent engagement with their clinicians, which ultimately led to better patient compliance with behavioral changes and medication use. Asynchronous visits can also speed up the time it takes for patients to receive advanced therapies, such as Botox injections, tibial nerve stimulation, or sacral neuromodulation. Often, insurance companies require at least two drug trials before approving advanced treatment options, and asynchronous visits allow clinicians to optimize treatment more quickly and try different drugs, instead of waiting. 90 days for the patient to return for a follow-up visit.
The researchers plan to conduct a randomized clinical trial to test whether asynchronous visits improve OAB outcomes compared to regular office care. “If we can confirm the effectiveness of this delivery model in a randomized trial, we hope this platform will become more widely available for other medical conditions,” says Ortega. In addition to keeping patients engaged in follow-up care, asynchronous visits offer many other benefits, such as the absence of cameras, the reduction of unnecessary medical visits, and the convenience of receiving care remotely, especially in rural areas where few specialists practice. .
Ortega is an instructor at Harvard Medical School (HMS) and a member of the Massachusetts General Physicians Organization Management. Other key authors are Marcela del Carmen, MD, MPH, president of the Massachusetts General Physicians Organization and professor of obstetrics, gynecology, and reproductive biology at HMS; May Wakamatsu, MD, director of female pelvic medicine and reconstructive surgery and vice president of gynecology at the MGH; and Jason Wasfy, MD, MPhil, medical director of the Massachusetts General Physicians Organization, director of quality and analysis at MGH Heart Center, and associate professor of medicine at HMS.
Source of the story: