Abstract
Introduction and hypothesis
The objective of this study was to evaluate the impact of patient- and physician-directed education in the primary care setting on screening, diagnosis, treatment, and referral patterns to Urogynecology for urinary incontinence (UI).
Methods
This was a prospective, multi-phase, before-and-after study conducted over a 3-year period. New female patients, 40 years and older, seen in the Internal Medicine (IM) clinic of our institution, were included. Phase 1 intervention consisted of UI lectures for IM residents. Phase 2 intervention involved placement of patient-directed posters throughout the IM clinic. Prior to phase 1, charts of new patients were reviewed as the control group to establish a baseline rate of screening, diagnosis, treatment initiation, and referrals. The same data were collected for 4 months after both phase 1 and phase 2. A washout period of 1 year occurred between phase 1 and phase 2.
Results
A total of 410 charts were reviewed and included 200 control, 92 phase 1, and 118 phase 2 patients. In the control group, 13% of patients were screened for UI. There was no significant increase in screening after phase 1 (15% vs 13%, p = 0.6); however, there was a significant increase after phase 2 (32.2% vs 13%, p < 0.001). There was no difference in treatment initiation for patients with a positive screen after either phase.
Conclusion
In our study, providing an informative lecture to an IM referral base did not improve UI screening. Alternatively, directly targeting patients through posters significantly improved screening rates in the primary care setting, demonstrating that simple interventions can improve screening for conditions that are difficult to discuss such as UI.
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Acknowledgements
There are no conflicts of interest from the authors of this study. All individuals who have contributed significantly to the work are listed as authors. The Committee of Interns and Residents is a funding source for quality improvement projects in Los Angeles County and funded the production and printing of the study’s posters. They played no role in poster design or content.
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Committee of Interns and Residents, Los Angeles County.
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Sarah Eckhardt: manuscript writing; Yoko Takashima: manuscript writing; Jessica Zigman: project design, data collection, manuscript writing; Valerie Yuan: data collection, manuscript writing; Pedro Alvarez: data collection, manuscript writing; Christina Truong: project design, manuscript writing; Tajnoos Yazdany: project design, manuscript writing.
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Eckhardt, S., Takashima, Y., Zigman, J. et al. The impact of physician-directed and patient-directed education on screening, diagnosis, treatment, and referral patterns for urinary incontinence. Int Urogynecol J 33, 2121–2126 (2022). https://doi.org/10.1007/s00192-022-05187-5
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DOI: https://doi.org/10.1007/s00192-022-05187-5