RT Journal Article
SR Electronic
T1 Effectiveness of an intervention to optimise the use of mirabegron for overactive bladder: a quasi-experimental study in primary care
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e852
OP e859
DO 10.3399/bjgp18X699953
VO 68
IS 677
A1 Eladio Fernández-Liz
A1 Pere Vivó Tristante
A1 Antonio Aranzana Martínez
A1 Maria Estrella Barceló Colomer
A1 Josep Ossó Rebull
A1 Maria Josep López Dolcet
A1 on behalf of the Urinary Incontinence Improvement Investigators Group
YR 2018
UL http://bjgp.org/content/68/677/e852.abstract
AB Background Overactive bladder is a composite of lower urinary tract storage symptoms. Pharmacological treatment is widely employed despite markedly modest efficacy data, adverse effects, and costs for the health system.Aim To determine the 12-month efficacy of an intervention delivered by GPs on mirabegron revision and, if appropriate, discontinuation of treatment.Design and setting Multicentre, quasi-experimental study in Barcelona (Catalonia), Spain.Method Two groups composed of 17 intervention and 34 control practices were formed. The follow-up period was 12 months, from 1 January to 31 December 2017. A structured intervention was designed consisting of initiatives with GPs and urology/gynaecology specialists. The primary outcome was mirabegron use at 12 months.Results Of the 1932 patients, a significant discontinuation in treatment was observed at 12 months’ follow-up in the intervention group (IG) (n = 433 out of 762, 56.8%), in contrast with the control one (CG) (n = 484 out of 1170, 41.4%) (P<0.001). There was also a reduced incorporation of new treatments in the IG (n = 214 out of 762, 28.1%) compared with the CG (n = 595 out of 1170, 50.9%) (P<0.001). In relation to patients with treatment at the beginning and end of the period, there was a decrease of 219 (28.7%) patients in the IG and an increase of 111 (9.5%) in the CG (P<0.001).Conclusion The structured intervention showed optimisation in the use of mirabegron. When considering discontinuation it is necessary to provide clear data on the benefits and/or risks for patients and their caregivers, as such information is a precondition for shared decision making.