Wong Jennifer Wh, Kaneshiro Bliss E, Oyama Ian A
Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI.
Hawaii J Med Public Health. 2019 Apr;78(4):132-136.
Primary care physicians (PCPs) play a major role in patient access to appropriate health care. This study examines PCPs' perceptions and management of female pelvic floor disorders. Surveys were mailed to family medicine and internal medicine physicians associated with the Hawai'i Medical Service Association. A total of 150 respondents were included. Only 34%, 38%, and 9% of respondents correctly identified the prevalence of urinary incontinence (UI), overactive bladder (OAB), and pelvic organ prolapse (POP), respectively. For disease-specific screening, the highest response was that PCPs "sometimes" screen for UI (36%) and OAB (45%) but "hardly ever" screen for POP (43%). With regards to management of UI and OAB, respondents would either treat (30% UI, 39% OAB) or start treatment then refer (53% UI, 49% OAB). For POP, nearly all of respondents (81%) would immediately refer. When consultation is necessary, there was a similar rate of referral to urology and urogynecology for UI (38% urology, 42% urogynecology), and a similar rate of referral to gynecology and urogynecology for POP (47% gynecology, 48% urogynecology). For OAB, PCPs would refer to urology (54.0%), then urogynecology (31%), and lastly gynecology (13%). A majority of respondents were "somewhat familiar" (56%) with urogynecology as a subspecialty, while 27% were "very familiar", 13% were "slightly unfamiliar", and 3% were "very unfamiliar". This study shows that most PCPs are not comfortable managing common urogynecologic problems and would likely benefit from education on how to diagnose, treat, and refer for these conditions in order to optimize patient care.
初级保健医生在患者获得适当医疗保健方面发挥着重要作用。本研究调查了初级保健医生对女性盆底疾病的认知和管理情况。调查问卷被邮寄给与夏威夷医疗服务协会相关的家庭医学和内科医生。总共纳入了150名受访者。只有34%、38%和9%的受访者分别正确识别了尿失禁（UI）、膀胱过度活动症（OAB）和盆腔器官脱垂（POP）的患病率。对于特定疾病的筛查，最高的回应是初级保健医生“有时”筛查UI（36%）和OAB（45%），但“几乎从不”筛查POP（43%）。关于UI和OAB的管理，受访者要么进行治疗（UI为30%，OAB为39%），要么开始治疗然后转诊（UI为53%，OAB为49%）。对于POP，几乎所有受访者（81%）都会立即转诊。当需要会诊时，UI转诊至泌尿外科和妇科泌尿学的比例相似（泌尿外科为38%，妇科泌尿学为42%），POP转诊至妇科和妇科泌尿学的比例相似（妇科为47%，妇科泌尿学为48%）。对于OAB，初级保健医生会转诊至泌尿外科（54.0%），然后是妇科泌尿学（31%），最后是妇科（13%）。大多数受访者（56%）“有点熟悉”妇科泌尿学这一亚专业，而27%“非常熟悉”，13%“有点不熟悉”，3%“非常不熟悉”。本研究表明，大多数初级保健医生对管理常见的妇科泌尿问题并不得心应手，可能会从关于如何诊断、治疗和转诊这些疾病的教育中受益，以便优化患者护理。
