title: Barriers experienced by patients with multiple sclerosis in seeking care for lower urinary tract symptoms.
abstract: OBJECTIVE
  The Actionable Bladder Symptom and Screening Tool (ABSST) is used to identify multiple sclerosis (MS) patients in possible need of evaluation for urinary symptoms. The primary objective of this study was to identify barriers experienced by MS patients in seeking evaluation for urinary symptoms. We also assessed the utility of ABSST tool in identifying patients that will follow up with urologic evaluation.
  
  
  METHODS
  This was a prospective observational study where 100 patients with MS were enrolled from an MS center. Patients completed demographic information, questions to assess barriers to care, a short form of the ABSST, and incontinence questionnaires. An ABSST score >3 met criteria for referral and evaluation. One year after enrollment, follow up calls assessed whether patients had seen a urinary specialist.
  
  
  RESULTS
  The most common barriers to seeking care included "Doctor never referred" (16%) and "Doctor never asked" (13%). Thirty-eight percent (n = 8/21) of men stated "Doctor never referred" compared to 10% (n = 8/79) of women (P = 0.002). Twenty-seven patients had an ABSST Score ≥3 and were more interested in seeing a specialist compared to those scoring <3 (88.9%, n = 24/27 vs. 26%, n = 19/73; P = <0.001). After 1 year, 70 patients were reached for follow up. A total of 57.9% (n = 11/19) patients who followed up for evaluation screened positive on the ABSST.
  
  
  CONCLUSIONS
  The ABSST is a valuable tool to identify MS patients with urinary symptoms who will likely follow up for genitourinary evaluation. However, other barriers beyond awareness exist and prevent patients from being evaluated.
authors.affiliation: Department of Urology, NYU Langone Medical Center, New York, New York.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Brucker
authors.affiliation: Department of Urology, NYU Langone Medical Center, New York, New York.
authors.forename: Victor W
authors.initials: VW
authors.lastname: Nitti
authors.affiliation: Department of Urology, NYU Langone Medical Center, New York, New York.
authors.forename: Sidhartha
authors.initials: S
authors.lastname: Kalra
authors.affiliation: Department of Neurology, NYU Langone Medical Center, New York, New York.
authors.forename: Joseph
authors.initials: J
authors.lastname: Herbert
authors.affiliation: Department of Urology, NYU Langone Medical Center, New York, New York.
authors.forename: Areeba
authors.initials: A
authors.lastname: Sadiq
authors.affiliation: Department of Neurology, NYU Langone Medical Center, New York, New York.
authors.forename: Puspa
authors.initials: P
authors.lastname: Utomo
authors.affiliation: Deparment of Urogynecology, Kaiser Permanente, Los Angels, California.
authors.forename: Margarita M
authors.initials: MM
authors.lastname: Aponte
mesh_terms: D000328:Adult; D003142:Communication; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D010342:Patient Acceptance of Health Care; D010817:Physician-Patient Relations; D011446:Prospective Studies; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D053201:Urinary Bladder, Overactive / Q000175:diagnosis / Q000209:etiology / Q000628:therapy
keywords: barriers to care; multiple sclerosis; neurogenic bladder; neurogenic detrusor overactivity