Supplements | The Clinical, Social, and Economic Implications of Neurogenic Bladder in Managed Care: Optimizing Patient Management and Outcomes [CPE/CME]

CME Information

Release date: July 15, 2013 |  Expiration date: July 15, 2014
Estimated time to complete activity: 2.5 hours
Type of Activity: Knowledge
Medium: Print with internet-based posttest, evaluation, and request for credit.

This activity is supported by an educational grant from Allergan, Inc.

Intended Audience
Medical directors, pharmacy directors, specialty pharmacists, and other managed care professionals who oversee the treatment of patients with neurogenic bladder.

Statement of Educational Need
Neurogenic bladder (NGB) is a disorder of the lower urinary tract created by damage to or diseases of the nervous system. Found in many patients with various neurological disorders (eg, multiple sclerosis, Parkinson’s disease, spinal cord injury), NGB may lead to problematic symptoms and complications including urinary incontinence, frequency, and urgency; infection; involvement of the upper urinary tract; and kidney disease. While the clinical disease burden alone is difficult for patients and those managing their disorders, the significant negative impact of NGB on health-related quality of life and associated economic costs can be devastating for patients already burdened with neurological disorders. Healthcare utilization may be excessive in patients with NGB, including office and emergency department visits and subsequent hospitalizations. Clinicians managing affected patients are faced with a myriad of complex choices when deciding upon appropriate medical and/or surgical interventions to relieve bothersome symptoms, especially urinary incontinence. Therapies must provide maximum benefits while minimizing risk for adverse events. A thorough knowledge and understanding of available and emerging medical and surgical treatment options for NGB is vital in choosing appropriate treatment pathways and optimizing response to therapy and individual outcomes.

This supplement to The American Journal of Managed Care is intended to provide an understanding of the pathophysiology of NGB and its impact on patient health and quality of life. The discussion will include an overview of appropriate diagnosis and assessment of patients with NGB/neurogenic detrusor overactivity and a review of roles, benefits, and risks of approved and emerging therapies. Also included is an analysis of economic and healthcare utilization impact associated with NGB and its consequences.

Educational Objectives
Upon completion of the educational activity, the participant should be able to:
  • Evaluate the pathophysiology of neurogenic bladder and its impact on patient health and quality of life
  • Diagnose and assess patients with neurogenic bladder/neurogenic detrusor overactivity to plan therapy and management
  • Distinguish the roles, benefits, and risks of approved and emerging therapies for neurogenic bladder/neurogenic detrusor overactivity
  • Delineate the economic and healthcare utilization impact associated with neurogenic bladder and its consequences

Activity Fee
Physician: This activity is free of charge for physician participants requesting AMA PRA Category 1 Credit™.
Pharmacist: The activity is free for participants submitting evaluation forms and posttests online for Pharmacy Credit.
For participants submitting their posttests/evaluation forms and requests for credit via fax or mail, there is a nominal fee of $10.00.

Disclosure Policy
According to the disclosure policies of Pharmacy Times Office of Continuing Professional Education and the University of Cincinnati, all persons who are in a position to control content are required to disclose any relevant financial relationships with commercial interests. If a conflict is identified, it is the responsibility of Pharmacy Times Office of Continuing Professional Education and the University of Cincinnati to initiate a mechanism to resolve the conflict(s). The existence of these relationships is not viewed as implying bias or decreasing the value of the activity. All educational materials are reviewed for fair balance, scientific objectivity of studies reported, and levels of evidence.

Physician Credit
Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the University of Cincinnati and Pharmacy Times Office of Continuing Professional Education. The University of Cincinnati is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
The University of Cincinnati designates this Enduring Material activity for a maximum of 2.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Pharmacist Credit
Accreditation and Credit Designation

Pharmacy Times Office of Continuing Professional Education is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 2.5 contact hours (.25 CEUs) under the ACPE universal activity number 0290-9999-13-144-H01-P. The activity is available for CE credit through July 15, 2014.

Obtaining Credit: Participants must read each article in this supplement, complete the posttest achieving a passing score of 70% or higher, and complete an evaluation and request for credit. Detailed instructions on obtaining CE credit are included on the evaluation/posttest page contained in this supplement.

Off-Label Disclosure and Disclaimer
The contents of this CME/CE supplement may include information regarding the use of products that may be inconsistent with or outside the approved labeling for these products in the United States. Physicians and pharmacists should note that the use of these products outside current approved labeling is considered experimental and are advised to consult prescribing information for these products.

For additional information about approved uses, including approved indications, contraindications, and warnings, participants are advised to consult prescribing information for all products discussed. The information provided in this CME/CE activity is for continuing medical and pharmacy education purposes only and is not meant to substitute for the independent medical or pharmacy judgment of a physician or pharmacist relative to diagnostic, treatment, or management options for a specific patient’s medical condition.

The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of The American Journal of Managed Care, The University of Cincinnati, the Pharmacy Times Office of Continuing Professional Education, or any of the companies that provided commercial support for this CME/CE activity.

David Ginsberg, MD
Associate Professor of Clinical Urology
Department of Urology
Keck School of Medicine
University of Southern California
Los Angeles, California

Chief, Department of Urology
Rancho Los Amigos National Rehabilitation Center
Downey, California

William J. Cardarelli, PharmD
Director of Pharmacy Revenue and Supply
Atrius Health
Harvard Vanguard Medical Associates
Watertown, Massachusetts

Contributing Editorial Support

Elizabeth Paczolt, MD, FACNM
Medical Consultant
Churchville, Pennsylvania

Faculty Disclosures
These faculty have disclosed the following relevant commercial financial relationships or affiliations in the past 12 months.

David Ginsberg, MD
Consultant or paid advisory board/honoraria: Allergan, Inc, American Medical Systems, and Pfizer
Lecture fees for speaking at the invitation of a commercial sponsor: Allergan, Inc

William J. Cardarelli, PharmD, and Elizabeth Paczolt, MD, FACNM, have no relevant financial relationships with commercial interests to disclose.

The American Journal of Managed Care
Publishing Staff—Jeff D. Prescott, PharmD, RPh; Kara Guarini, MS; and Ida Delmendo have no relevant financial relationships with commercial interests to disclose.

Pharmacy Times Office of Continuing Professional Education
Planning Staff—Judy V. Lum, MPA; David Heckard; Elena Beyzarov, PharmD; Donna W. Fausak; Ann C. Lichti, CCMEP; and Steve Lin, PharmD, RPh, have no relevant financial relationships with commercial interests to disclose.

University of Cincinnati
Planning Staff—Susan P. Tyler, MEd, CMP, CCMEP, has no relevant financial relationships with commercial interests to disclose.
Physician Reviewer—Rick Ricer, MD, has no relevant financial relationships with commercial interests to disclose.

Signed disclosures are on file at the office of The American Journal of Managed Care, Plainsboro, New Jersey.

Opinions expressed by authors, contributors, and advertisers are their own and not necessarily those of Clinical Care Targeted Communications, LLC, d/b/a Managed Care & Healthcare Communications, LLC, the editorial staff, or any member of the editorial advisory board. Clinical Care Targeted Communications, LLC, d/b/a Managed Care & Healthcare Communications, LLC, is not responsible for accuracy of dosages given in articles printed herein. The appearance of advertisements in this publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality, or safety. Clinical Care Targeted Communications, LLC, d/b/a Managed Care & Healthcare Communications, LLC, disclaims responsibility for any injury to persons or property resulting from any ideas or products referred to in the articles or advertisements.

Publisher’s Note: The opinions expressed in this supplement are those of the authors, presenters, and/or panelists and are not attributable to the sponsor or the publisher, editor, or editorial board of The American Journal of Managed Care. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this supplement are not necessarily the same as indicated in the package insert for the product and may reflect the clinical experience of the authors, presenters, and/or panelists or may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.

System Requirements
PC-based participants
Windows 7, Vista, XP, 2003 Server, or 2000

Macintosh®-based participants
Required: Mac OS X 10.4.11 (Tiger) or newer

© 2013 Managed Care & Healthcare Communications, LLC




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