Bridging Community-based Continence Promotion and Primary Care

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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.