Improving Lower Urinary Tract Symptoms through Interdisciplinary Research and Collaboration between Primary and Specialty Care

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RESEARCH PROJECT SUMMARY Nearly 50% of adult women, including as many as 37% of women aged 30-50, report at least one episode of urinary incontinence. There are several effective nonpharmacologic interventions for mild or early symptoms, including pelvic floor exercises, which may resolve incontinence for up to 50% of patients with early disease. For more severe cases or those who fail nonpharmacologic interventions, seven antimuscarinics (also called anticholinergics) and one B-3 agonist (B-adrenergic) are FDA-approved, and vaginal estrogen, botulinum toxin, urethropexy, urethral bulking, sling surgeries, and neurostimulation all show substantial benefits in some populations of women. However, symptom burden remains high, and the field needs innovative strategies to target effective treatments to the appropriate patients. Urinary incontinence could be better managed using these available treatments though improved collaboration between primary and specialty care. Promising approaches to improve chronic care should be studied in urinary incontinence, which could help with recognition and initial treatment of stress and urgency urinary incontinence across large populations in primary care, as well as foster the link with specialty care and improve referral patterns. Our team has built innovative tools to allow routine electronic measurement of patient-reported outcomes using patient portals. We also have expertise utilizing digital health and other nontraditional delivery of health interventions, with a focus on improving equity as well. Given this background, we propose interdisciplinary team development, pilot and feasibility work with the following aims. Aim 1) To routinely measure patient-reported urinary incontinence in a racially diverse population of adult women in primary care. Aim 2) To pilot test a guideline-based incontinence care pathway that integrates primary and specialty care. Aim 3) To utilize the health system's clinical data warehouse to establish a registry in which to estimate the prevalence and equity of current incontinence health care utilization. This will provide data about the potential eligibility for future studies among female primary care patients and help identify the highest priority points for future intervention. We will pursue these aims in an academic health system with over 2.8 million patient visits yearly.