Improving Women's Health by Using an Electronic Pelvic Floor Questionnaire

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DESCRIPTION (provided by applicant): Project Summary Incontinence is an important women's health issue that can have devastating personal, occupational, social and economic consequences. According to the published literature the prevalence of both urinary and fecal incontinence greatly outstrips detection and treatment. The reasons for this are multi-factorial and include both reluctance on the part of patients to bring up the symptoms and a lack of screening on the part of physicians. Patients often assume that incontinence is a normal part of aging or they may lack awareness that there are effective treatments. They are also sometimes too embarrassed to raise the issue. Physicians are often under time constraints and may prioritize other health problems. Sometimes they share the same misconceptions as patients. The challenge is to determine how to improve physician awareness and to facilitate patient reporting. While most authors have focused on patient or provider education, this project proposes a novel approach to the problem. The hypothesis is that the use of an electronic pelvic floor assessment questionnaire (e-PAQ) will improve communication about incontinence by facilitating patient reporting and by providing physicians with a comprehensive summary of a patient's pelvic floor symptoms. Because the e-PAQ also assesses the degree to which symptoms are problematic for patients as well as the impact on quality of life, the summary report enables physicians to efficiently focus on the symptoms that are most problematic to the patient. The overall goal of this project is to test whether an electronic pelvic floor questionnaire (e-PAQ) increases discussion rates of urinary and fecal incontinence in a primary care setting. A prospective controlled trial is being performed, in which women 40 years of age and older are randomized to receive the e-PAQ either before or after their primary care well visit. The primary outcome measure is whether urinary incontinence is discussed as determined by review of clinic note and also by patient report. Differences in assessment and treatment rates for urinary incontinence between the two arms will also be assessed. The question of whether administration of the e-PAQ prior to the visit increases the discussion rate of fecal incontinence and whether there are any differences in the assessment and treatment of fecal incontinence will also be explored. Finally, the information obtained by review of the clinic note will be compared with the information obtained from the patients and the concordance rate of the two sources will be calculated. Public Health Relevance: Project narrative Incontinence is a highly prevalent condition which can have devastating personal, social and economic consequences for the individual sufferer and also has a high societal cost. Many individuals do not receive available effective treatments because incontinence is often not discussed in the primary care setting. This study will determine whether having women fill out an electronic pelvic floor assessment questionnaire prior to their primary care clinic visit will improve the discussion rates of urinary and/or fecal incontinence during the visit