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

研究项目总结 近50%的成年女性，包括高达37%的30-50岁的女性，报告至少有一次 尿失禁。对于轻微或早期症状，有几种有效的非药物干预措施， 包括盆底锻炼，这可能会解决高达50%的早期疾病患者的尿失禁问题。 对于更严重的病例或那些非药物干预失败的患者，七种抗心肌梗死药(也称为 抗胆碱药物)和一种B-3激动剂(B-肾上腺素能)是FDA批准的，阴道雌激素，肉毒杆菌毒素， 尿路固定术、尿路扩张术、吊带手术和神经刺激在某些情况下都显示出显著的益处。 女性人口。然而，症状负担仍然很高，该领域需要创新战略来 针对适当的患者进行有效的治疗。尿失禁可以更好地使用 这些可用的治疗通过改善初级保健和专科护理之间的协作而得以实现。前景看好 应该研究改善尿失禁长期护理的方法，这可能有助于 初级人群中压力性和紧迫性尿失禁的识别和初步治疗 护理，以及促进与专科护理的联系，并改善转诊模式。我们的团队已经建立了创新的 允许使用患者门户对患者报告的结果进行常规电子测量的工具。我们还有 利用数字健康和其他非传统提供健康干预措施的专门知识，重点是 也提高了公平性。在这种背景下，我们建议跨学科团队发展，试点和 可行性工作的目标如下。目的1)常规测量患者报告的尿失禁 种族多样化的成年妇女在初级保健中的人口。目标2)试行测试基于指南的尿失禁 整合了初级护理和专科护理的护理路径。目的3)利用卫生系统的临床数据 仓库建立一个登记处，在其中估计当前失禁健康的流行率和公平性 护理利用情况。这将提供有关女性初级保健中未来研究的潜在资格的数据 并帮助确定未来干预的最高优先事项。我们将通过一个 学术卫生系统，每年有超过280万名患者就诊。

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.