Improving resident screening and workup of urinary incontinence in an OB/GYN residency program: a randomized controlled study.

OBJECTIVES

: With an aging US population, an increased prevalence of urinary incontinence, rising health care costs, and a disease that remains largely unidentified, there is an immediate need to train physicians to screen for and treat incontinence. We aim to evaluate resident physician screening of urinary incontinence with a chart-based review.

METHODS

: This study entailed 2 parts: a retrospective chart review (part 1) and a prospective randomized trial (part 2). Charts of 200 patients were retrospectively evaluated for documentation of bladder symptoms and incontinence for part 1. In part 2, patients' charts were prospectively randomized to receive a chart-alert sticker ("Do you leak urine?") that reminded resident physicians to ask about urinary incontinence in their general gynecology clinics. The primary outcome was documentation of urinary incontinence. Secondary outcomes were initiation of workup, diagnoses made, and treatment plans. Overall, 200 charts were needed for the prospective study to provide 80% power.

RESULTS

: Residents documented any type of bladder symptom (incontinence, urgency, frequency, dysuria, nocturia) in 32 (16.3%) of 196 charts in part 1 and 45 (23.7%) of the 190 randomized charts in part 2 (P = 0.154). In the prospective study, 88 included charts were randomized to receive the "Do you leak urine?" chart-alert sticker and 102 were randomized to no sticker. Residents documented that they asked about incontinence in 30 (34.1%) of the charts with stickers versus 4 (3.9%) of the charts without (P = 0.001).

CONCLUSIONS

Overall, the rate that resident physicians inquired about incontinence increased with the alert-sticker from 4% to 34%. Directed education will likely further this improvement.