Home electrical stimulation for urinary incontinence: a study of the diffusion ofa new technology.

The objective of this study was to investigate the extent to which physicians requested home electrical stimulation (ES) treatment for patients with urinary incontinence (UI). Home ES was requested by 429 general practitioners (GPs) and 147 gynecologists within 2 years (1992 to 1994) after the Norwegian National Insurance Service offered reimbursement for the procedure. For first-time requesters, cumulative plots of time to request were compared for GPs versus gynecologists. Characteristics of requesting GPs were compared with those of a randomly selected control sample of nonrequesting GPs, collected by postal questionnaire. A greater proportion of gynecologists than GPs prescribed home ES during the 2-year study period (42% vs 14%, P <0.001). Median time to request for ES was 5.8 months for gynecologists versus 8.6 months for GPs (P <0.01). A greater proportion of female GPs than male GPs requested the treatment (17% vs 13%, P <0.01). Sufficient information about and/or knowledge of treatment indications were claimed by 71% of requesting GPs versus 21% of controls (P <0.001). Altogether, 91% of requesters versus 62% of controls judged that home ES was effective or a good treatment alternative (P <0.001). Requesters (versus controls) prescribed more bladder training and estrogen for urge UI, more pelvic floor exercises and estrogen to treat stress UI, and more ES to treat both types of UI (all P <0.05). Gynecologists prescribed ES more often and earlier than GPs. Prescribers of ES were more proactive in treating UI in their practices than those who were not prescribers.