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，包括多达37%的30-50岁的女性，报告至少有一次 尿失禁对于轻度或早期症状，有几种有效的非药物干预措施， 包括骨盆底锻炼，这可以解决高达50%的早期疾病患者的尿失禁。 对于更严重的病例或非药物干预失败的病例， 抗胆碱能药）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， 尿道固定术、尿道扩张术、悬吊术和神经刺激术在某些情况下都显示出实质性的益处。 妇女人口。然而，症状负担仍然很高，该领域需要创新策略， 将有效的治疗方法用于适当的患者。尿失禁可以更好地管理， 这些可用的治疗方法，虽然改善初级和专科护理之间的合作。有前途 应研究改善尿失禁患者慢性护理的方法， 大规模原发性压力性和急迫性尿失禁患者的识别和初步治疗 护理，以及促进与专科护理的联系和改善转诊模式。我们的团队建立了创新的 允许使用患者门户网站对患者报告的结局进行常规电子测量的工具。我们也有 利用数字健康和其他非传统健康干预措施的专业知识，重点是 也改善了公平性。鉴于这种背景，我们建议跨学科的团队发展，试点和 可行性研究的目标如下。目的1）常规测量患者报告的尿失禁， 初级保健中的成年妇女的种族多样性。目的2）对基于指南的尿失禁进行初步测试 整合初级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，以估计目前尿失禁健康的患病率和公平性 护理利用率这将为女性初级保健的未来研究提供潜在资格数据 帮助确定未来干预的最高优先级。我们将以一种 学术卫生系统，每年有超过280万病人就诊。

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.