Increasing Discussion Rates of Incontinence in Primary Care: A Randomized Controlled Trial.
Increasing Discussion Rates of Incontinence in Primary Care: A Randomized Controlled Trial.
复制标题
提高初级保健中失禁的讨论率：一项随机对照试验。
DOI：
10.1089/jwh.2015.5230
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
Wald,Arnold
中科院分区：
文献类型：
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作者：
Schüssler-FiorenzaRose,SophiaMiryam;Gangnon,RonaldE;Chewning,Betty;Wald,Arnold
背景：少数女性尿失禁（UI）和大便失禁（FI）报告在过去的一年中与卫生保健提供者讨论过。因此，我们的目的是评估是否使用电子骨盆底评估问卷（ePAQ-PF）提高沟通失禁在primary care.Methods：妇女40岁及以上谁被安排在2007年8月和2008年8月之间的内科诊所每年的健康体检随机完成ePAQ-PF之前（n= 145）或之后（n= 139）他们的访问。干预组女性的临床医生在访视前收到ePAQ-PF报告。临床记录摘要的结局指标包括提及UI（原发性）和FI。受试者报告的结果测量包括UI和FI的讨论和讨论的发起者。结果：UI的讨论在干预组比对照组更常见：（27%对19%;比值比[OR]，1.6，95%置信区间[95%CI] 0.9-2.8，特别是60岁以上的女性（33%对12%; OR 3.8，95%CI 1.2-11.8）和UI女性（42% vs. 25%; OR 2.2，95%CI 1.1-4.1）。干预主要导致临床医生发起的UI讨论增加，这在干预组中更常见（18% vs. 4%，OR 4.8，95%CI 1.9-12.0）干预组的参与者更频繁地报告FI的讨论（14% vs. 6%; OR 2.5，95%CI 1.1-6.0），超过一半的病例是由临床医生发起的（9% vs. 3%; OR 3.5，95%CI 1.1-11.0）。结论：在门诊访视前使用ePAQ-PF增加了对UI和FI的讨论，特别是临床医生发起的讨论。这些研究结果表明，这些工具可能会增加这种往往“沉默”的痛苦的检测和治疗。
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.