Although specialists are skilled in the management of urinary incontinence, primary care clinicians are integral in early diagnosis and initiation of management in order to decrease overuse of specialty care and improve the quality of specialist visits.
We measured the quality of incontinence care provided by primary care clinicians before referral to a specialist and evaluated the impact of provider variables on quality of care.
We performed a retrospective review of 200 women referred for urinary incontinence to a Female Pelvic Medicine and Reconstructive Surgery specialist between March 2017-July 2018. We measured primary care adherence to twelve quality indicators in the twelve-months prior to specialist consultation. We stratified adherence to quality indicators by clinician gender and years of experience.
Half of women with incontinence underwent a pelvic exam or had a urinalysis ordered. Few patients with urge urinary incontinence were recommended behavioral therapy (14%) or prescribed medication (8%). When total aggregate scores were compared, female clinicians performed the recommended care 47 +/- 25% of the time compared to 35 +/- 23% for male clinicians (p=0.003). Increasing years of experience was associated with worse overall UI care (r -0.157, p=0.02).
We found low rates of adherence to a set of quality indicators for women with urinary incontinence, with male clinicians performing significantly worse than female clinicians. Improvement of incontinence care in primary care could significantly reduce costs of care and preserve outcomes.
The American journal of medicine. 2021 Nov 30 [Epub ahead of print]
Claire S Burton, Gabriela Gonzalez, Eunice Choi, Catherine Bresee, Teryl K Nuckols, Karyn S Eilber, Neil S Wenger, Jennifer T Anger
Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California., David Geffen School of Medicine at UCLA, Los Angeles, California., Division of Urology, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California., Biostatistics Core, Cedars Sinai Medical Center, Los Angeles, California., Division of General Internal Medicine, Cedars Sinai Medical Center, Los Angeles, CA., Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA., Department of Urology, UC San Diego, La Jolla, CA. Electronic address: .
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