Quality and associated factors of guideline-concordant primary care referral for urinary incontinence and pelvic organ prolapse: A single centre retrospective observational study.

OBJECTIVE

Evaluate the appropriateness of primary care referrals for urinary incontinence and pelvic organ prolapse against national guideline standards, and to identify patient characteristics associated with inappropriate referral using univariable analyses.

STUDY

DESIGN

Retrospective service evaluation of all primary care referrals to a urogynaecology service at a UK district general hospital over a twelve-month period. Referrals were categorised as urinary incontinence or pelvic organ prolapse and assessed against predefined criteria derived from NICE NG123.

RESULTS

A total of 869 referrals were analysed, comprising 518 urinary incontinence and 351 prolapse referrals. Just over half of urinary incontinence referrals (54.1%) met guideline criteria for appropriate referral, compared with only 8.0% of prolapse referrals. In the incontinence group, increasing age was significantly associated with inappropriate referral on univariable analysis (p = 0.039). In the prolapse cohort, increasing age (p < 0.001) was also significantly associated with inappropriate referral on univariable analysis. For BMI ≥30 kg/m2, the unadjusted odds ratio suggested a possible but non-significant trend towards higher odds of inappropriate referral in prolapse group. (OR 2.54, 95% CI 0.86-7.51).

CONCLUSIONS

Adherence to national guidance for pelvic floor disorder management in primary care was suboptimal, particularly for pelvic organ prolapse. Older women showed higher unadjusted odds of referral without full conservative management on univariable analyses. These findings support targeted education, clearer referral pathways, and improved access to community pelvic health services to optimise referral quality.