In pilot study, asynchronous telehealth visits effectively treat
overactive bladder

Date:
March 9, 2022
Source:
Massachusetts General Hospital
Summary:
Women with overactive bladder are frequently frustrated with
treatment, which leads to discontinuation of therapy. Asynchronous
telehealth visits keep women engaged in follow-up care, accelerates
trials of different medications and reinforces behavioral
changes. The women in this pilot study reported improvement in
symptoms and high satisfaction with asynchronous visits.



FULL STORY ========================================================================== Women who received treatment for overactive bladder (OAB) using
asynchronous telehealth visits had significant improvement in their
symptoms and high satisfaction with their care, concludes an exploratory
pilot study published in Menopause.


========================================================================== Overactive bladder is a common disorder that affects one in five
women. This condition dramatically affects the quality of life
of women affected by it, but treatment adherence is notoriously
low. "Successful treatment of overactive bladder often requires both
medication and altering behavior, such as reducing the amount of
liquids consumed and cutting back on beverages containing caffeine,
a bladder irritant," says first author Marcus Ortega, MD, a female
pelvic medicine and reconstructive surgeon at Massachusetts General
Hospital (MGH). "Patients often discontinue medications because of side effects, and the behavioral changes aren't easy to make without positive reinforcement and objective proof that they are effective. We wanted to
test whether we could enhance treatment by keeping patients engaged in
care and expediting therapy options." The 23 women enrolled in the pilot
study had been newly diagnosed with OAB during an in-person outpatient
visit at 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 from their initial in-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 answers, the clinician responded with
specific recommendations. "For example, the clinician might recommend
switching to a different medication because of side effects or lack
of efficacy, or reinforce certain behaviors to improve symptoms,"
Ortega explains.

"The patient's answers on the validated medical questionnaires also allow
us to objectively compare over time whether symptoms are improving,
since it can be difficult for patients to keep track of subjective
symptoms month after month." The study participants completed a
total of 50 e-visits over a mean 135 days, with most women completing
two telehealth visits. All study participants had a statistically
significant improvement in urinary symptoms and a decrease in the number
of incontinence episodes between their first asynchronous visit and the
last one. The women reduced their fluid intake, including caffeinated and carbonated beverages, and more than 30% switched medications or had the
dosage adjusted. Participants were very satisfied with the experience,
rating the asynchronous visits an 8.8 on a 10-point satisfaction scale.

Despite the recent advances in overactive bladder therapies, nearly 50%
of patients are frustrated with treatment results. The investigators
attribute the participants' improvement in urinary symptoms in this study
to more frequent engagement with their clinicians, which ultimately led
to the patients' better compliance in behavioral changes and medication
use. Asynchronous visits may also accelerate the time for patients to
receive advanced therapies, such as Botox injections, tibial nerve
stimulation, or sacral neuromodulation. Often, insurance companies
require at least two medication trials before approving advanced treatment options, and asynchronous visits allow clinicians to more quickly optimize treatment and try different medications, as opposed to waiting 90 days
for the patient to return for a follow-up office visit.

The investigators plan to conduct a randomized clinical trial to test
whether asynchronous visits improve outcomes in OAB compared with regular office-based care. "If we can confirm the efficacy 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 advantages, such as not requiring a camera, reduction in
unnecessary medical visits, and the convenience of receiving care at a distance, especially in rural areas where few specialists practice.

Ortega is an instructor at Harvard Medical School (HMS) and a
Massachusetts General Physicians Organization Management Fellow. 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 chair of Gynecology
at MGH; and Jason Wasfy, MD, MPhil, medical director of the Massachusetts General Physicians Organization, director of Quality and Analytics at
the MGH Heart Center, and associate professor of Medicine at HMS.


========================================================================== Story Source: Materials provided by Massachusetts_General_Hospital. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Marcus V. Ortega, Marcela G. del Carmen, May Wakamatsu, Susan A.

Goldstein, Eirian Siegal-Botti, Jason H. Wasfy. Asynchronous
telehealth visits for the treatment of overactive
bladder. Menopause, 2022; Publish Ahead of Print DOI:
10.1097/GME.0000000000001957 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/03/220309104406.htm

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