Adoption of Single-Use Clean Intermittent Catheterization Policies Does Not Appear to Affect Genitourinary Outcomes in a Large Spinal Cord Injury Cohort.

Abstract

PURPOSE:

In April 2008, Medicare amended its policy for clean intermittent catheterization, increasing coverage from 4 reused catheters per month to up to 200 single-use catheters. The primary reason for the policy change was an assumed decrease in risk of urinary tract infection with single-use catheters. Given its economic/environmental impact (∼50-fold increase in cost and plastic waste) and a paucity of supporting evidence, we retrospectively evaluate the policy's effect in a prospective spinal cord injury registry.

MATERIALS AND METHODS:

We accessed data for the years 1995 to 2020 from the National Spinal Cord Injury Database focusing on 1-year follow-up in those unable to volitionally void after injury. We asked 2 questions: (1) Did hospitalizations for genitourinary reasons decrease after the clean intermittent catheterization policy change?; and (2) Did clean intermittent catheterization adoption and adherence increase after the clean intermittent catheterization policy change?

RESULTS:

During the study period, 2,657 of the 6,843 (38.8%) participants unable to volitionally void after spinal cord injury were hospitalized during their first follow-up year. Of the cohort performing clean intermittent catheterization, fewer individuals were hospitalized for genitourinary reasons prior to the clean intermittent catheterization policy change compared to after (10.6% vs 14.6%, P < .001), a finding that persisted on multivariate logistic regression (odds radio, 0.67, P < .001). In addition, the number of individuals performing clean intermittent catheterization at 1-year follow-up was less after the policy change compared to prior (57.0% vs 59.1%, P = .044).

CONCLUSIONS:

Our findings suggest the 2008 policy change shifting clean intermittent catheterization coverage from catheter reuse to single-use did not decrease hospitalizations for urinary tract infection or increase clean intermittent catheterization uptake in individuals with spinal cord injury.

• Authors: Christopher S Elliott, Kai Dallas, Kazuko Shem, James Crew
• Journal: The Journal of urology (J Urol) Vol. 208 Issue 5 Pg. 1055-1074 (11 2022) ISSN: 1527-3792 [Electronic] United States
• PMID: 35748685 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Plastics

Topics

• Aged
• Humans
• Intermittent Urethral Catheterization
• Medicare
• Plastics
• Policy
• Prospective Studies
• Retrospective Studies
• Spinal Cord Injuries
• United States (epidemiology)
• Urinary Bladder, Neurogenic
• Urinary Catheterization
• Urinary Tract Infections (epidemiology, etiology, prevention & control)