title: Increasing Discussion Rates of Incontinence in Primary Care: A Randomized Controlled Trial.
abstract: BACKGROUND
  A minority of women with urinary incontinence (UI) and even fewer with fecal incontinence (FI) report having discussed it with a health care provider in the past year. Thus our aim was to evaluate whether the use of an electronic pelvic floor assessment questionnaire (ePAQ-PF) improves communication about incontinence in primary care.
  
  
  METHODS
  Women 40 years and older who were scheduled for an annual wellness physical at an internal medicine clinic between August 2007 and August 2008 were randomized to complete the ePAQ-PF prior to (n = 145) or after (n = 139) their visit. Clinicians of women in the intervention group received the ePAQ-PF report prior to the visit. Outcome measures from clinic note abstraction included mention of UI (primary) and FI. Participant-reported outcome measures included discussion of UI and FI and initiator of discussion.
  
  
  RESULTS
  Discussions of UI was more common in the intervention group than the control group: (27% vs. 19%; odds ratio [OR], 1.6 95% confidence interval [95%CI] 0.9-2.8, particularly for women over 60 (33% vs. 12%; OR 3.8, 95%CI 1.2-11.8) and for women with UI (42% vs. 25%; OR 2.2, 95%CI 1.1-4.1). The intervention primarily led to an increase in clinician-initiated UI discussions which were more common in the intervention group (18% vs. 4%, OR 4.8, 95%CI 1.9-12.0) Participants in the intervention group more frequently reported discussion of FI (14% vs. 6%; OR 2.5, 95%CI 1.1-6.0) which was clinician initiated in over half the cases (9% vs. 3%; OR 3.5, 95%CI 1.1-11.0).
  
  
  CONCLUSIONS
  Use of the ePAQ-PF prior to clinic visits increases discussion of UI and FI, particularly clinician-initiated discussion. These findings suggest that such instruments may increase the detection and treatment of this often "silent" affliction.
authors.affiliation: 1 Spinal Cord Injury Service, Veteran Affairs Palo Alto Health Care System , Palo Alto, California.|2 Department of Neurosurgery, Stanford University , Stanford, California.
authors.forename: Sophia Miryam
authors.initials: SM
authors.lastname: Schüssler-Fiorenza Rose
authors.affiliation: 3 Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.|4 Department of Biostatistics and Medical Informatics, School of Pharmacy, University of Wisconsin , Madison, Wisconsin.
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Gangnon
authors.affiliation: 5 Department of Sonderegger Research Center, School of Pharmacy, University of Wisconsin , Madison, Wisconsin.
authors.forename: Betty
authors.initials: B
authors.lastname: Chewning
authors.affiliation: 6 Department of Medicine, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.
authors.forename: Arnold
authors.initials: A
authors.lastname: Wald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D005242:Fecal Incontinence; D005260:Female; D006801:Humans; D008875:Middle Aged; D009819:Office Visits; D017063:Outcome Assessment, Health Care; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence