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Developing a urinary incontinence primary care pathway: a mixed methods study. Fam Pract 2024 Oct 08;41(5):798-806

Date

07/19/2024

Pubmed ID

39026426

Pubmed Central ID

PMC11461143

DOI

10.1093/fampra/cmae035

Scopus ID

2-s2.0-85206018320 (requires institutional sign-in at Scopus site)

Abstract

BACKGROUND: While nearly 50% of adult women report at least one episode of urinary incontinence (UI), most never receive treatment.

OBJECTIVE: To better integrate primary and specialty UI care, we conducted (i) an environmental scan to assess the availability of key pathway resources in primary care, (ii) interviews with primary care providers to understand barriers to care, and (iii) a pilot UI care pathway intervention.

METHODS: Environmental scan: Clinic managers from all primary care clinics within a Midwestern healthcare system were invited to participate in an interview covering the availability of clinic resources. Provider interviews: Primary care providers were invited to participate in an interview covering current practices and perceived barriers to UI care. Pilot UI care pathway: Patients who screened positive for UI were provided resources for first-line behavioral management. Pilot patients completed questionnaires at baseline, 8 weeks, and 6 months.

RESULTS: While many clinics had point-of-care urinalysis (17/21, 81%), most did not have a working bladder ultrasound (14/21, 67%) or on-site pelvic floor physical therapy (18/21, 86%). Providers (nā€…=ā€…5) described barriers to completing almost every step of diagnosis and treatment for UI. The most persistent barrier was lack of time. Patients (nā€…=ā€…15) reported several self-treatment strategies including avoiding bladder irritants (7/15, 47%) and performing Kegel exercises (4/15, 27%). Five patients (33%) requested follow-up care. At 6 months, patients reported small improvements in UI symptoms.

CONCLUSION: Promising results from a novel UI care pathway pilot indicate that streamlining UI care may assist primary care providers in the first-line treatment of UI.

Author List

Luebke MC, Neuner JM, Balza J, Davidson ERW, Hokanson JA, Marowski S, Corey O'Connor R, Schmitt E, Winn AN, Flynn KE

Authors

Emily Davidson MD Associate Professor in the Obstetrics and Gynecology department at Medical College of Wisconsin
Kathryn Eve Flynn PhD Vice Chair, Professor in the Medicine department at Medical College of Wisconsin
James A. Hokanson PhD Assistant Professor in the Biomedical Engineering department at Medical College of Wisconsin
Joan Neuner MD, MPH Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Critical Pathways
Female
Health Services Accessibility
Humans
Interviews as Topic
Male
Middle Aged
Pilot Projects
Primary Health Care
Surveys and Questionnaires
Urinalysis
Urinary Incontinence