The effects of implementation of the Agency for Health Care Policy and Research urinary incontinence guidelines in primary care practices.
OBJECTIVE
To determine whether a multifaceted intervention based on the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guidelines for Urinary Incontinence would increase primary care physician screening for and management of urinary incontinence (UI).


METHODS
Group randomized trial, conducted from 1996 to 1997.


METHODS
Internal medicine and family medicine community practices.


METHODS
Forty-one primary care practices, including 57 physicians and their staff and 1,145 patients aged 60 and older.


METHODS
Twenty of the 41 primary care practices in North Carolina were randomized to a composite intervention that included a 3-hour continuing medical education accredited course, training in management of UI, patient educational materials, and on-site physician and office support. The remaining 21 practices served as "usual care" controls. Telephone surveys of UI status and quality of life were obtained from 1,145 patients before the intervention. At 1 year, patients and physicians were contacted by telephone and mail to determine the effect of the educational intervention.


METHODS
Patients completed telephone surveys to assess screening for UI, UI status, treatment interventions, and quality of life. Physicians completed surveys related to UI treatment and practice patterns.


RESULTS
Baseline and endpoint telephone surveys were completed by 668 of 1,145 (58%) of patients, who were cared for by 45 physicians (10 internists, 35 family medicine). Physician screening rates for UI were 22% for those patients who did not report UI. UI was reported by 39.5% of patients at baseline, of whom 30% reported being asked about UI by their primary care physician during the study. Rates of assessment and management of existing UI were low in both the control and intervention groups. Additional historical questioning indicated that 54.2% reported that they had ever undergone assessment, including history, urinalysis, or testing, or had had management of their UI by any physician.


CONCLUSIONS
Attempts at increasing screening and management of UI by primary care physicians using the AHCPR standardized guidelines using a multifaceted system of educational and logistical support were not successful. These guidelines may not be the best approach to treating UI in the primary care setting.
Bland
Deirdre R
DR
Blue Ridge Medical Associates, Winston-Salem, North Carolina 27103, USA. Bland-blueridge@triad.rr.com
Dugan
Elizabeth
E
Cohen
Stuart J
SJ
Preisser
John
J
Davis
Cralen C
CC
McGann
Paul E
PE
Suggs
Patricia K
PK
Pearce
Katherine F
KF
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019538:Health Care Surveys / Q000592:standards; D006284:Health Plan Implementation / Q000592:standards*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D011788:Quality of Life; D011897:Random Allocation; D014481:United States; D016270:United States Agency for Healthcare Research and Quality / Q000592:standards*; D014549:Urinary Incontinence / Q000175:diagnosis* / Q000628:therapy*