From a healthcare systems perspective, chronic conditions represent some of the most challenging healthcare needs to address. Studies in both the United States and Canada consistently demonstrate that these conditions are amongst those with the widest variations in their utilization of resources – driven not by clinical guidelines, but the availability of services in the local area [1, 2]. When poorly managed, chronic conditions can also result in expensive acute incidents, requiring hospitalization and potentially more complicated care .
To help manage these conditions and defray the costs associated with their care, patient self-management is often advocated . Under this, patients are expected to help manage their condition by avoiding behaviors that exacerbate symptoms and perform minor interventions themselves. Underlying the self-management principal is that patients have a good understanding of their condition, its management, and treatments.
Overactive bladder (OAB) is an example of a chronic condition that is expensive to manage through the healthcare system, and proper patient self-management can minimize those costs. A recent survey of Canadians approximated that 2.1 million individuals had the condition, costing provincial healthcare systems $380 million per year to care for .
As a first step to designing a formal self-management program, a multidisciplinary outpatient urology clinic based in Calgary, Alberta set out to study how much patients diagnosed with OAB knew about their condition. It was hypothesized that patients with more severe OAB symptoms would be more knowledgeable about the condition and its associated treatments compared to those with less severe OAB, either because of education from their primary care physician or through self-education.
To test this hypothesis, the investigators created a 20-item survey to distribute to patients with OAB who had been referred to the clinic from their primary care physician. This survey included questions concerning the nature of OAB symptoms, as well as questions about treatment options and the potential side effects of such treatments. Symptom severity was measured using two common OAB patient-reported outcomes measures, the OAB-V8  and the IPSS .
A convenience sample of 87 patients completed the survey. These patients had an average symptom score on the OAB-V8 of 19.1 (out of 40, indicating possibility of OAB) and 11.4 on the IPSS (out of 35, indicating moderate urinary symptoms). The mean survey score was 8.2 (out of 20). There was a significant difference in knowledge of OAB and patients’ self-reported symptom severity on the IPSS. For every unit increase in the IPSS, there was a.08 unit decrease in the survey score (t=-2.08, p=.04, 95% CI=-.16 to -.004). There was no relationship between knowledge of OAB and patient’s self-reported responses to the OAB-V8.
These results lead to several lines of thoughts. First, the average survey score was well below what was expected. This indicates that the general knowledge of OAB was poor. Second, the negative correlation between the survey score and the symptom severity was counter to the hypothesized relationship. This could be for several reasons, but perhaps indicates that patients have more severe symptoms because they don’t understand the underlying reasons.
The results also present an opportunity to design better interventions to inform patients about their OAB. Such interventions should be used at the primary care level, before patients are referred to specialty care. This would ensure that those patients being referred to secondary care setting require the intensity of those services. Improving the knowledge of OAB would lead to better access and appropriateness of care.
Andrea Civitarese, B.Sc. is a research assistant at vesia [Alberta Bladder Centre] in Calgary, Alberta.