Different Disorders, Similar Challenges

In this special issue of The Consultant Pharmacist, we’ll explore current strategies for management of urinary incontinence and HIV disease—conditions that, while quite dissimilar in many ways, are quite similar in many others.

Both incontinence and HIV disease remain underdiagnosed and under-reported among the elderly. Both are surrounded by a persistent cloud of social stigma and shame, often resulting in delayed diagnosis, disease progression, and, consequently, more complicated treatment.

The similarities don’t end there. Both incontinence and HIV disease continue to exact a heavy toll on the health care system, not only in terms of direct treatment costs (an estimated $13.3 billion and $7 billion, respectively, each year in the United States alone), but also in terms of decreased productivity, diminished quality of life, and other less tangible but equally “real” costs.

For all the reasons cited above, both incontinence and HIV disease continue to pose major pharmacotherapy challenges. In many cases, clinicians’ failure to differentiate distinct subtypes of incontinence leads to poor drug selection and suboptimal, possibly counterproductive treatment; in other cases, appropriate management with the right mix of behavioral and pharmacologic therapies too often takes a back seat to stopgap measures such as use of diapers, absorbent pads, and indwelling catheters. Turning to HIV disease, achievement of optimal outcomes is often complicated by delayed diagnosis, poor compliance, and the complexity, potential toxicity—and high cost—of multidrug regimens.

Despite these challenges, an expanding array of pharmaceutical agents is enabling more effective drug therapy for many patients with incontinence and HIV disease—provided such therapy is properly targeted, vigilantly monitored, and assiduously managed.

That brings us to one more important similarity between incontinence and HIV disease. Both conditions present many opportunities for astute consultant pharmacists: opportunities to serve as coordinators and facilitators of a multidisciplinary approach to care; opportunities to spearhead prevention and early detection of side effects, drug-drug interactions, and other subtle, often insidious problems that can derail or diminish the effectiveness of pharmacotherapy; and opportunities to play a key role in addressing the myriad complex psychosocial issues and challenges faced by seniors with incontinence or HIV disease.

If consultant pharmacists are to seize those opportunities, they’ll need to acquire, hone, and constantly update their skills in diagnosis and treatment of incontinence and HIV disease while being attuned to the psychosocial issues that have a major bearing on patient care outcomes. We hope the information and guidance presented in the following pages will contribute to that process.

David K. Buerger
Managing Editor