Sub-optimal diagnosis of neurogenic bladder among general practitioners in the United Kingdom—evidence from the Clinical Practice Research Datalink

The diagnosis rate for neurogenic bladder (NGB) in the United Kingdom (UK) is surprisingly low. A lack of a clear diagnosis for patients adds ambiguity to their characterisation, treatment pathways and impedes meaningful research. A correct diagnosis means patients are more likely to have access to appropriate services and the right medical treatments, which subsequently improves their chances of optimal health outcomes as well as reducing healthcare costs. Accordingly, the aim of this research was to speculate the reasons for suboptimal diagnosis in NGB and provide recommendations for improvement. Nine hundred and sixty-seven patients were diagnosed with NGB between 2004–2015 in the Clinical Practice Research Datalink (CPRD) database, which in the context of the literature, seems low. Possible reasons include inadequate medical coding, a lack of awareness of urological symptoms amongst non-urologist healthcare professionals (HCPs), failure to follow clinical guidelines in practice, the exclusion of NGB from the Quality Outcomes Framework (QoF) scheme and an accommodation of urological symptoms. For optimal management in NGB, closing the current diagnosis gap is essential. Deprived of a diagnosis, patients will face an uphill battle in gaining access to services and appropriate medications. Measures such as educational campaigns, financial incentives, better use of clinical decision support systems (CDSS) and fostering better relationships between important stakeholders will be instrumental in achieving optimal diagnosis rates. Furthermore, additional hypothesis testing research is essential to ascertain the actual determinants of referrals.