The quality of care provided to vulnerable older community-based patients with urinary incontinence.
OBJECTIVE
The objective of this study was to assess the quality of care provided to vulnerable older community-based patients with urinary incontinence (UI).


METHODS
We conducted an observational study using medical record review and patient (or proxy) interview.


METHODS
We studied 372 randomly selected community-dwelling older patients enrolled in two senior managed care plans identified by interview to be at increased risk for functional decline or death.


METHODS
Percentage of quality indicators passed for patients with UI.


RESULTS
Thirty-six percent of the patients reported having UI, and during a 13-month period, 32 (7%) presented to their physician with new or worsening UI. Analysis of medical records for these 32 patients revealed that characteristics of voiding were documented for 75% of the patients with new or worsening UI, but importance of the problem, toileting function, and prior treatment were rarely addressed. Pelvic examination was performed for 20% of female patients and a rectal examination for 42% of men. Only 38% had a urinalysis performed and 16% had a postvoid residual. Drug treatment was prescribed for 50% of the patients but behavioral intervention for only 13%. Compared with patients seen by primary care providers alone, patients seen in consultative care received more comprehensive evaluation and treatment of UI.


CONCLUSIONS
Quality of care for UI provided to vulnerable older patients, particularly by primary care providers alone, is inadequate. Despite the proven effectiveness of patient-dependent behavioral treatments, physicians rarely prescribe these interventions for UI.
Gnanadesigan
Nallini
N
Los Angeles Jewish Home for the Aging, 7150 Tampa Avenue, Reseda, CA, USa. nallini@pacbell.net
Saliba
Debra
D
Roth
Carol P
CP
Solomon
David H
DH
Chang
John T
JT
Schnelle
John
J
Smith
Rick
R
Shekelle
Paul G
PG
Wenger
Neil S
NS
D000368:Aged; D000369:Aged, 80 and over; D001521:Behavior Therapy / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000592:standards* / Q000706:statistics & numerical data; D005194:Family Practice / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006299:Health Services for the Aged / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000592:standards* / Q000706:statistics & numerical data; D008499:Medical Records; D010817:Physician-Patient Relations; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires; D013997:Time Factors; D014549:Urinary Incontinence / Q000453:epidemiology / Q000628:therapy*