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

描述(由申请人提供)：项目摘要大小便失禁是一个重要的妇女健康问题，可能会对个人、职业、社会和经济造成毁灭性的后果。根据已发表的文献，尿失禁和大便失禁的患病率大大超过了检测和治疗。其原因是多方面的，既包括患者不愿提出症状，也包括医生缺乏筛查。患者通常认为大小便失禁是衰老的正常部分，或者他们可能没有意识到有有效的治疗方法。他们有时也会因为太尴尬而不愿提出这个问题。医生经常受到时间限制，可能会优先考虑其他健康问题。有时，他们与病人有着相同的误解。挑战是确定如何提高医生的意识并促进患者报告。虽然大多数作者都专注于患者或提供者的教育，但这个项目提出了一种新的方法来解决这个问题。假设是，使用电子盆底评估问卷(e-PAQ)将通过促进患者报告并向医生提供患者盆底症状的全面摘要，来改善有关失禁的沟通。由于e-PAQ还评估症状对患者的问题程度以及对生活质量的影响，因此总结报告使医生能够有效地专注于对患者最有问题的症状。这个项目的总体目标是测试电子盆底问卷(e-PAQ)是否增加了初级保健环境中尿失禁和大便失禁的讨论率。一项前瞻性对照试验正在进行中，40岁及40岁以上的妇女随机接受e-PAQ，在她们的初级保健井就诊之前或之后。主要的结果衡量标准是通过回顾临床记录和患者报告确定是否讨论了尿失禁。还将评估两个分支机构在尿失禁评估和治疗率方面的差异。还将探讨在就诊前使用e-PAQ是否会增加大便失禁的讨论率，以及在大便失禁的评估和治疗方面是否存在任何差异。最后，将通过审查临床病历获得的信息与从患者那里获得的信息进行比较，计算两个来源的符合率。 公共卫生相关性：项目叙述性大小便失禁是一种高度流行的疾病，可能会对个体患者造成毁灭性的个人、社会和经济后果，也会造成很高的社会成本。许多人得不到有效的治疗，因为大小便失禁通常不在初级保健环境中讨论。这项研究将确定，在初级保健诊所就诊之前，让妇女填写一份电子盆底评估问卷是否会提高就诊期间尿失禁和/或大便失禁的讨论率。

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