Approximately 10 million Americans, mostly elderly, suffer from urinary incontinence (UI). Most affected individuals have not told a health care provider either because of shame or lack of awareness of help. Of those who had not told, most said that they would or might seek help if treatment were available. Alternatively, most primary care providers do not routinely screen patients for UI and many are unaware of the gamut of treatments available. Given the widespread prevalence of inadequate diagnosis and management of UI and the estimated $10 billion cost for its management, the Agency for Health Care Policy and Research convened an expert panel to review the scientific literature and produce guidelines for identifying and evaluating UI and its optimal behavioral, pharmacological and surgical management. Nevertheless, the ramification of UI guideline adherence on multiple patient outcomes awaits explication.
The aim of the proposed study is to conduct a randomized, controlled trial with 40 primary care practices (20 intervention and 20 control) to foster the adoption and implementation of the UI guidelines by primary care providers and determine the impact of UI guideline adoption on the UI severity status, health status, health-related quality of life and satisfaction with care of about 600 patients equal to or over 60 years of age who report being symptomatic for Ui. Approximately 6,000 patients will be contacted to assess whether they were screened for UI and if they are symptomatic (i.e., UI cohort). Also tracked will be primary care providers' attitudes, beliefs and guideline adherence and their office- staff attitudes and beliefs. The study is a joint effort between investigators from the Bowman Gray School of Medicine and the Northwest Regional Office of the North Carolina Area Health Education Center and will employ methodology developed in our previous and current research, namely: 1) assess physician and office- staff readiness to change, 2) design, implement and tailor interventions to increase motivation for change (practice feedback and help from respected influentials) and enhance practice logistical support (identify a within practice coordinator, provide """"""""user-friendly"""""""" patient screening forms and chart flow sheets and interact frequently with the practice to create a continuous quality improvement system for UI screening, assessment and management), and 3) validly and reliably assess the impact of the interventions on providers' guideline adherence and the effect of UI guideline adoption on a wide variety of patient outcomes through baseline and end point medical record reviews and patient surveys.
| Dugan, E; Roberts, C P; Cohen, S J et al. (2001) Why older community-dwelling adults do not discuss urinary incontinence with their primary care physicians. J Am Geriatr Soc 49:462-5 |
| Dugan, E; Cohen, S J; Bland, D R et al. (2000) The association of depressive symptoms and urinary incontinence among older adults. J Am Geriatr Soc 48:413-6 |
