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Perceptions, Practices Vary on Urinary Incontinence Screening


 

HOLLYWOOD, FLA. — Although most primary care physicians recognize the importance of diagnosis and treatment of urinary incontinence, routine screening is not always done, according to survey results presented at the annual meeting of the American Urogynecologic Society.

Although “98% of primary care physicians consider screening somewhat or very important, only 60% screen their patients all [or most] of the time,” Dr. Gunhilde M. Buchsbaum said.

Dr. Buchsbaum and her associates mailed a survey to 1,466 primary care physicians practicing in Monroe County, New York state, to determine perceptions and practices regarding urinary incontinence screening. Of the 554 responses, 43% were from internists, 28% from family physicians, 23% from obstetricians and gynecologists, and 6% from geriatricians. The majority of the respondents (65%) were 35–54 years old; 61% were men, and 83% were white. A total of 58% were in private practice.

“We asked about their overall perception of the importance of urinary incontinence screening,” said Dr. Buchsbaum, director of urogynecology and reconstructive pelvic surgery at the University of Rochester (N.Y.) Medical Center.

A total of 42% felt that such screening was “very important,” and another 56% replied it was “somewhat important.” Broken down by specialty, the following perceived screening as “very important”: 63% of geriatricians, 58% of ob.gyns., 43% of internists, and 30% of family physicians.

The researchers asked how routinely these primary care physicians screen for urinary incontinence. A total of 18% replied “always,” 42% said “most of the time,” 26% replied “occasionally,” and 14% indicated they “rarely or never” screen their patients.

The propensity to screen varied by specialty as well, with ob.gyns. and geriatricians more likely to report screening all or most of the time, compared with internists and family physicians.

Among physicians not routinely screening, time constraints were cited by 38% as the primary reason. Another 27% cited reimbursement concerns, 23% pointed to a lack of support staff, and 12% indicated they would not know what to do about a positive result, Dr. Buchsbaum said.

Physician comfort with diagnosis of urinary incontinence and use of conservative management were associated with higher screening rates, she said. Ob.gyns. and geriatricians more often said they were “very comfortable” or “somewhat comfortable” with diagnosis, compared with internists and family physicians.

Physicians were asked about additional education regarding urinary incontinence. Overall, 75% indicated they wanted to learn more, particularly those younger than 35 years and those who had been in practice for less than 10 years. “Although many are interested in learning more about urinary incontinence, only 35% feel it [screening] will alter their practice,” Dr. Buchsbaum said.

Based on these findings, the researchers suggested that continuing medical education programs on urinary incontinence for primary care physicians be targeted in particular at younger and less-experienced physicians.

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