To 1) describe primary care provider (PCP) practices for the assessment and management of females with urinary incontinence (UI), and 2) appraise these practices relative to recommendations made in high-quality clinical guidelines.
Studies were searched in four databases (Medline, EMBASE, CINAHL, Web of Science) from their respective inception dates to March 6, 2023. All studies describing UI evaluation and management practices used by PCPs for female patients were eligible. Two reviewers independently selected studies, assessed their quality and extracted data. A narrative synthesis of included studies was performed to describe practices. Relevant evaluation and management practices were then compared to recommendations that were consistent across current high-quality UI guidelines. Pharmacotherapy, referrals and follow-ups were reported descriptively only.
A total of 3475 articles were retrieved and, among those, 31 were included in the review. The majority reported a poor to moderate adherence to performing a pelvic exam (reported adherence range: 23-76%; based on n=8 studies), abdominal examination (0-87%; n=3), pelvic floor muscle assessment (9-36%; n=2), and bladder diary (0-92%; n=9), while there was high adherence to urinalysis (40-97%; n=9). For the conservative management of UI, studies revealed a poor to moderate adherence to recommendations for pelvic floor muscle training (5-82%; n=9), bladder training (2-53%; n=8) and lifestyle interventions (1-71%; n=6). Regarding pharmacotherapy, PCPs predominantly prescribed antimuscarinics (2-46%; n=9) and estrogen (2-77%; n=7). Lastly, PCPs referred those reporting UI to medical specialists (5-37%; n=14). Referrals were generally made less than 30 days after diagnosis with urologists being the most sought out professional to assess and treat UI.
This review revealed poor to moderate adherence to clinical practice guideline recommendations. While these findings reflect high variability in reporting, the key message is that most aspects of patient care for female UI provided by PCPs needs to improve.
BJU international. 2023 Nov 30 [Epub ahead of print]
Marylène Charette, Lissa Pacheco-Brousseau, Stéphane Poitras, Rosalind Ashton, Linda McLean
Population Health, Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada., School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada., Department of Family Medicine, University of Ottawa, Ottawa, Canada.