OBJECTIVES:

This study examined treatment patterns and predictors of adherence to antimuscarinic medications among long-stay nursing home residents with Overactive Bladder (OAB).

METHODS:

This retrospective cohort study used 2013-2015 Minimum Data Set linked Medicare data involving elderly (≥65 years) long-stay nursing home residents (nursing home stay ≥101 consecutive days) with a diagnosis of OAB. The outcome was adherence to antimuscarinic medications based on medication possession ratio (MPR). MPR was defined as the proportion of days a patient had a supply of antimuscarinic medications after the nursing home admission until the end of the nursing home stay. MPR ≥0.8 was considered adherent to antimuscarinic drugs. Descriptive statistics was performed to determine treatment pattern of antimuscarinic medications. Multivariable logistic regression model was performed to determine predictors of adherence to antimuscarinic medications.

RESULTS:

The cohort included 56,707 long-stay residents with OAB who used antimuscarinic medications during their nursing home stay. The most commonly prescribed antimuscarinics were oxybutynin (69.9%), solifenacin (22.8%), and tolterodine (18.3%). Of the patients taking antimuscarinic medications, 59.37% were adherent to antimuscarinics. Patients with index prescriptions of darifenacin (OR 0.68, 95% CI 0.61–0.76), solifenacin (OR 0.87, 95% CI 0.83–0.91), tolterodine (OR 0.90, 95% CI 0.86–0.95), and trospium (OR 0.85, 95% CI 0.76–0.95) were less likely adhere to antimuscarinic drugs. Patients with prior antimuscarinic use (OR 1.21, 95% CI 1.17–1.25) and multiple antimuscarinic drugs (OR 1.55, 95% CI 1.19–2.01) were more likely to adhere to antimuscarinic medications. Several other demographic and clinical factors were also associated with antimuscarinic medication adherence.

CONCLUSIONS:

Approximately 60% of long-stay nursing home residents with OAB were adherent to antimuscarinic medications. The study found significant variation in medication adherence based on the index antimuscarinic agent. Concerted efforts are needed to improve medication adherence to improve quality of care of OAB in nursing homes.