Automated Screening and Education for Women With Urinary Incontinence in Primary Care

Urinary incontinence (UI) in women is common and diminishes quality of life. While treatable, it is underreported.

To evaluate whether use of an automated UI screening and Identify, Teach, and Treat (IT2) educational initiative in primary care is associated with changes in incident UI diagnosis and rates of referral for pelvic floor therapy and subspecialty care.

This quality improvement study was conducted at a regional academic health system. Electronic health record (EHR) data were obtained for women who presented for annual visits at 1 of 43 primary care practices before and after implementation of an automated UI screening and IT2 initiative (January 1, 2023, to December 1, 2024).

IT2 automated screening and education workflows for UI in primary care practices. Women received a UI screening question electronically before or in person at their routine annual visits. Those patients with screening responses indicating bothersome UI and desiring more information were offered an online module about UI and its treatments. Primary care clinicians electronically received module results and an EHR alert and order set for interventions, including medications and physical therapy or subspecialty care referrals.

Interrupted time-series analysis with segmented linear regression was used to model practice-level rates of UI diagnosis and treatments to compare preimplementation and postimplementation rates.

A total of 72 009 women (median [IQR] age, 54 [38-67] years) were included in the analysis. IT2 was implemented at 43 primary care practices, and 72 009 screening responses were collected. Bothersome UI symptoms and the desire for more information were identified in 6578 women (9.1%). The mean (SD) clinic-level rate of UI diagnosis per 100 encounters was 4.2 (1.1) at baseline. At intervention start, there was an immediate step increase in UI diagnoses by 0.51 (95% CI, 0.12-0.91 per 100 encounters (P = .01), and the annual rate of diagnoses per 100 encounters continued to increase an additional 0.55 (95% CI, 0.05-1.05; P = .03) per 100 encounters. Pelvic floor physical therapy referrals followed a similar pattern, with an initial step increase of 0.38 (95% CI, 0.23-0.53) referrals per 100 encounters (P < .001), and an annual rate increase per 100 encounters of 0.31 (95% CI, 0.12-0.50; P = .001). At baseline, the rate of referral to subspecialty services was a mean (SD) of 0.5 (0.2) per 100 encounters and initially increased by a mean of 0.29 (95% CI, 0.16-0.41) per 100 encounters (P < .001) after IT2 implementation but thereafter remained constant. The rate of new prescriptions of UI medication did not change after IT2 implementation.

Findings of this study suggest that implementation of a large-scale, automated UI screening and education program is feasible and could be used to increase awareness and promote treatment of this condition among patients.