Mp19-08 determinants of Beta-3 Agonist Prescription for Overactive Bladder According to the Aua Quality Registry

Abstract

METHODS: FPMRS clinical practice logs were obtained from the American Board of Urology from 2013-21. We grouped encounters into FPMRS diagnostic groups and calculated the proportion of clinic visits to corresponding procedures. We performed multilevel logistic regression to evaluate variability between surgeons while accounting for surgeon gender, age, certification status, year and patient age.RESULTS: 370 FPMRS urologists submitted 383,424 clinic and 323,929 procedural encounters, of which 49% constituted FPMRSrelated diagnoses. Of these urinary incontinence (UI, 30%), overactive bladder (OAB; 26%), and urinary tract infections (14%) were most common. Diagnoses with the highest proportion of procedural visits (%) included pelvic organ prolapse (POP; 30%), UI (39%), and fistulas (50%), while interstitial cystitis (0%), neurogenic bladder (0%), and benign prostatic hyperplasia (4%) had the fewest associated procedures (Figure 1). Multilevel regression found that 15% of variance (intraclass correlation, ICC) in the proportion of FPMRS clinic visits to procedures was explained by clustering at the physician level and that increasing surgeon age was associated with a deceased proportion of clinic visits (Odds Ratio (OR): 0.99p[0.01).When evaluating diagnostic sub-groups, results were similar, with clustering under physicians explaining 14-19% of variance in clinic vs. procedural proportion depending on the diagnostic group. Increasing patient age was associated with increased clinic visits (fewer procedures) for OAB (OR[1.00 p<0.001), UI (OR[1.00 p<0.001), and POP (OR[1.01 p<0.001). Female physicians had 20% increased odds of having a clinic visit per procedure compared to male counterparts for UI (OR[1.25 p<0.001) and POP (OR[1.23 p[0.01).CONCLUSIONS: A large portion of FPMRS-urologists practice is non-operative and not sub-specialty related. Efforts that increase access to FPMRS-trained urologists may benefit from methods to triage non-operative management to physician extenders and focus practices on FPMRS care.