Bland Deirdre R, Dugan Elizabeth, Cohen Stuart J, Preisser John, Davis Cralen C, McGann Paul E, Suggs Patricia K, Pearce Katherine F
Blue Ridge Medical Associates, Winston-Salem, North Carolina 27103, USA.
J Am Geriatr Soc. 2003 Jul;51(7):979-84. doi: 10.1046/j.1365-2389.2003.51311.x.
To determine whether a multifaceted intervention based on the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guidelines for Urinary Incontinence would increase primary care physician screening for and management of urinary incontinence (UI).
Group randomized trial, conducted from 1996 to 1997.
Internal medicine and family medicine community practices.
Forty-one primary care practices, including 57 physicians and their staff and 1,145 patients aged 60 and older.
Twenty of the 41 primary care practices in North Carolina were randomized to a composite intervention that included a 3-hour continuing medical education accredited course, training in management of UI, patient educational materials, and on-site physician and office support. The remaining 21 practices served as "usual care" controls. Telephone surveys of UI status and quality of life were obtained from 1,145 patients before the intervention. At 1 year, patients and physicians were contacted by telephone and mail to determine the effect of the educational intervention.
Patients completed telephone surveys to assess screening for UI, UI status, treatment interventions, and quality of life. Physicians completed surveys related to UI treatment and practice patterns.
Baseline and endpoint telephone surveys were completed by 668 of 1,145 (58%) of patients, who were cared for by 45 physicians (10 internists, 35 family medicine). Physician screening rates for UI were 22% for those patients who did not report UI. UI was reported by 39.5% of patients at baseline, of whom 30% reported being asked about UI by their primary care physician during the study. Rates of assessment and management of existing UI were low in both the control and intervention groups. Additional historical questioning indicated that 54.2% reported that they had ever undergone assessment, including history, urinalysis, or testing, or had had management of their UI by any physician.
Attempts at increasing screening and management of UI by primary care physicians using the AHCPR standardized guidelines using a multifaceted system of educational and logistical support were not successful. These guidelines may not be the best approach to treating UI in the primary care setting.
确定基于医疗保健政策与研究机构（AHCPR）尿失禁临床实践指南的多方面干预措施是否会增加初级保健医生对尿失禁（UI）的筛查和管理。
1996年至1997年进行的组随机试验。
内科和家庭医学社区诊所。
41个初级保健机构，包括57名医生及其工作人员以及1145名60岁及以上的患者。
北卡罗来纳州41个初级保健机构中的20个被随机分配到综合干预组，该干预包括一门3小时的经认可的继续医学教育课程、尿失禁管理培训、患者教育材料以及现场医生和办公室支持。其余21个机构作为“常规护理”对照组。在干预前，从1145名患者那里获得了关于尿失禁状况和生活质量的电话调查。在1年时，通过电话和邮件联系患者和医生，以确定教育干预的效果。
患者完成电话调查以评估尿失禁筛查、尿失禁状况、治疗干预措施和生活质量。医生完成与尿失禁治疗和实践模式相关的调查。
1145名患者中的668名（58%）完成了基线和终点电话调查，这些患者由45名医生（10名内科医生，35名家庭医生）照料。对于未报告尿失禁的患者，医生的尿失禁筛查率为22%。在基线时，39.5%的患者报告有尿失禁，其中30%报告在研究期间被初级保健医生询问过尿失禁情况。在对照组和干预组中，对现有尿失禁的评估和管理率都很低。进一步的病史询问表明，54.2%的患者报告他们曾接受过评估，包括病史、尿液分析或检测，或者曾有任何医生对其尿失禁进行过管理。
通过多方面的教育和后勤支持系统，尝试利用AHCPR标准化指南提高初级保健医生对尿失禁的筛查和管理未获成功。这些指南可能不是在初级保健环境中治疗尿失禁的最佳方法。
