Bridging Community-based Continence Promotion and Primary Care

连接基于社区的失禁促进和初级保健

• 批准号: 10559587
• 负责人: Heidi Wendell Brown
• 金额: $ 38.1万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2023-07-07
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10559587
• 关键词: Bridging; Community; based; Continence; Promotion

PROJECT SUMMARY/ABSTRACT Urinary incontinence affects more than 18 million U.S. women and is associated with healthcare costs in excess of $18 billion annually, with increasing prevalence as our population ages. Incontinence limits quality of life and increases the risk of depression, falls, and institutionalization. Effective non-surgical solutions exist, but only half of women with incontinence discuss their symptoms with a healthcare provider. Primary care providers recognize the importance of diagnosing and treating incontinence but remain overburdened by increasing and overwhelming competing priorities, and thus incontinence remains underdiagnosed and undertreated. We will test two implementation strategies to help primary care clinics incorporate screening and treatment of urinary incontinence: Ask (screen); Advise (educate that incontinence is common and treatable); and Assist (offer evidence-based treatment), called UI-Assist. Recognizing that effective partnerships between primary care and public health agencies improve health and decrease burden when implemented successfully, we hypothesize that an implementation strategy that supplements streamlined practice facilitation with partnership building (engaging community resources, building coalitions, providing ongoing consultation, and creating an online learning community) will overcome known barriers to intervention implementation, resulting in broader reach and ultimately larger impact. We have engaged partners at the local, state, and national levels whose missions align with the proposed work and supporting primary care to improve treatment of urinary incontinence, increasing likelihood of sustainability and subsequent scale. We will compare the impact of streamlined practice facilitation versus streamlined practice facilitation with partnership building. Guided by Glasgow’s Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we will test our hypothesis through a type 3 hybrid cluster randomized trial of 50 primary care practices. We will use a difference-in-differences analyses that compares the proportion of patients who are (a) screened and (b) offered treatment for incontinence before and after implementation (Aim 1) by study arm. Using mixed methods, we will examine the impact of implementation strategy and contextual factors on UI-Assist’s Reach, Adoption, Implementation, and Maintenance (Aim 2) and on patient-reported outcomes (Aim 3), including symptom improvement, physical and social functioning, psychological symptoms, quality of life, coping strategies, economic concerns, and adverse events). As the prevalence of urinary incontinence continues to increase, and as primary care practices face increasing pressure to address more with less time and resources, scalable interventions and implementation strategies to improve care are urgently needed.

项目总结/摘要 尿失禁影响超过1800万美国妇女，并与医疗保健费用有关， 每年超过180亿美元，随着我们人口的老龄化，流行率越来越高。信息限制质量 生活和增加抑郁症的风险，福尔斯，和机构。有一些非手术治疗的方法，但 只有一半的失禁妇女与保健提供者讨论她们的症状。初级保健 提供者认识到诊断和治疗尿失禁的重要性，但仍然负担过重， 越来越多的和压倒性的竞争优先事项，因此失禁仍然诊断不足， 治疗不足我们将测试两种实施策略，以帮助初级保健诊所纳入筛查， 尿失禁的治疗：询问（屏幕）;建议（教育，尿失禁是常见的和可治疗的）; 而辅助（提供循证治疗），称为UI辅助。认识到， 初级保健和公共卫生机构在成功实施时可改善健康并减轻负担， 我们假设，一个实施战略，补充精简的做法促进与 伙伴关系建设（利用社区资源，建立联盟，提供持续的咨询， 创建在线学习社区）将克服实施干预措施的已知障碍， 更广的范围和最终更大的影响。我们与地方、州和国家层面的合作伙伴进行了合作 其任务与拟议的工作和支持初级保健，以改善泌尿系统疾病的治疗 失禁，增加可持续性和随后规模的可能性。我们将比较 简化的实践便利与简化的实践便利与伙伴关系建设。指导 格拉斯哥的覆盖、有效性、采用、实施和维护（RE-AIM）框架，我们将 通过对50个初级保健实践的3型混合群集随机试验来验证我们的假设。我们将使用一个 差异中差异分析，比较接受（a）筛选和（B） 按研究组在实施前和实施后提供失禁治疗（目标1）。使用混合 方法，我们将研究的影响，实施战略和上下文因素的UI辅助的范围， 采用、实施和维护（目标2）以及患者报告的结局（目标3），包括 症状改善，身体和社会功能，心理症状，生活质量，应对 战略、经济问题和不良事件）。随着尿失禁的流行， 随着初级保健实践面临越来越大的压力，需要在更短的时间内解决更多问题， 迫切需要资源、可扩展的干预措施和执行战略来改善护理。