Factors Influencing Physician Prescribing Practices for Overactive Bladder Pharmacotherapy: A Systematic Review.

OBJECTIVE

This study identifies factors influencing physician prescribing patterns for overactive bladder (OAB) pharmacotherapy.

METHODS

This systematic review adheres to the 2020 PRISMA guidelines. MEDLINE, Embase, and Web of Science were searched from inception to manuscript creation using tailored strategies, including terms like "beta-3 agonist," "anticholinergic," and "overactive bladder." Interventional or observational studies on physician prescribing for OAB were included; non-human, non-English, or full-text-unavailable studies were excluded. Two reviewers screened all records, with a third resolving conflicts. Reference lists of relevant articles were also reviewed. Risk of bias was assessed using AXIS, ROBUST, or ROBINS-E. Data extraction identified six themes, which were reviewed collaboratively and presented.

RESULTS

Of 1037 titles and abstracts reviewed, 48 were eligible for full-text review, and 18 were included in the final analysis. Conclusions were derived from an in-depth analysis of common underlying themes across included studies. The six themes identified as influencing physician initiation of overactive bladder medication were: (1) underlying medical comorbidities, (2) industry payments, (3) geographical differences, (4) patient clinical characteristics, (5) physician demographic characteristics, and (6) physician identified treatment goals.

DISCUSSION: This systematic review characterizes factors influencing physicians' prescribing of pharmacotherapy for the management of OAB. We highlight the complexity of factors, aside from the common considerations of cost and medical comorbidities, that may impact treatment selection for patients with OAB. The study is limited by the heterogeneity of available studies, which precludes quantitative comparison. More directed studies are needed to understand how physicians balance these competing factors with treatment recommendations for OAB.