Automated Screening and Education Increases Urinary Incontinence Diagnoses

Implementing an automated urinary incontinence screening and education program in primary care practices significantly increased awareness and treatment referrals in women with the condition, according to a recent study published in JAMA Internal Medicine.

Urinary incontinence (UI) — the loss of bladder control — is prevalent in more than half of women and occurs more often as women age.

For many patents, lifestyle changes can help improve symptoms. However, previous work has found that a woman’s lifetime risk of bothersome UI is 45 percent and that one in seven women will undergo surgery for UI in their lifetime. Despite this increased risk, many women do not seek treatment due to embarrassment or lack of knowledge about UI treatment.

“Epidemiological data shows that at any given time, 20 to 40 percent of women experience urinary incontinence and that most of them feel uncomfortable bringing this up directly to their primary care doctor. We knew that we were under-diagnosing urinary incontinence and therefore not serving our female population best,” said Julia Geynisman-Tan, MD, associate professor of Obstetrics and Gynecology in the Division of Urogynecology and Reconstructive Pelvic Surgery, who was a co-author of the study.

In the current study, the scientists aimed to determine whether implementing a universal screening question for UI during primary care visits followed by treatment education for women who screen positive for UI increases diagnoses and rates of treatment referral.

Electronic health record data were obtained for more than 72,000 women who presented for annual wellness visits at 43 primary care practices across Chicagoland before and after implementation of an automated UI screening and the Identify, Teach, and Treat (IT2) educational initiative. Patients received UI screening questions electronically before or at their annual wellness visits.

Patients who reported having bothersome UI and requested more information were offered an online module about UI and treatment options. The module also allowed patients to determine which treatment options would best meet their needs, and this information was then sent electronically to their primary care physician. 

Approximately 9 percent of patients reported bothersome UI symptoms and the desire for more information. The average clinic-level rate of UI diagnosis per 100 encounters was 4.2 at baseline.

When the intervention was implemented, the investigators observed an increase in UI diagnoses by 0.51 per 100 clinical encounters and the annual rate of diagnoses increased an additional 0.55 per 100 encounters. Pelvic floor physical therapy referrals also showed an increase of 0.38 referrals per 100 encounters and an annual rate increase of 0.31 per 100 encounters.

“In other words, in a health system that sees more than 100,000 annual wellness visits per year, this increase is detection results in thousands of additional cases of incontinence being identified and potentially referred for treatment,” Geynisman-Tan said.

“We saw significant increases in urinary incontinence diagnosis, pelvic floor physical therapy referrals and specialty referrals, which indicates that screening implementation did improve the recognition and increased management of this condition,” said Stephen Persell, MD, MPH, professor of Medicine in the Division of General Internal Medicine, and a co-senior author of the study.

The findings suggest that implementing automatic UI screening and educational programming in primary care practices can help increase awareness and treatment of UI in women.

“We plan to continue the universal screening going forward and continue to educate patients on the treatment options through a less involved process than we initially envisioned. All positive screens will be flagged for the PCP so that they are aware and can discuss the symptoms with the patient and come up with a plan,” Geynisman-Tan said.

Lucia Petito, PhD, assistant professor of Preventive Medicine in the Division of Biostatistics and Informatics, was also co-author of the study.

This study was supported by the Agency for Healthcare Research and Quality under award U18HS028744.