McDowell B J, Silverman M, Martin D, Musa D, Keane C
University of Pittsburgh School of Nursing, PA 15261.
J Am Geriatr Soc. 1994 May;42(5):501-5. doi: 10.1111/j.1532-5415.1994.tb04971.x.
To determine the difference in the recognition and intervention/referral rates for urinary incontinence (UI) by out-patient Geriatric Assessment Units (GAUs) and private physicians in community-based practices (CMDs).
A multi-site, randomized, controlled study where block randomization was utilized to assign subjects 65 years of age and older to either a GAU or a CMD for assessment.
One academic and three hospital-based GAUs and CMDs in private practice in a large metropolitan area.
Three hundred sixty-four community-dwelling frail men (14%) and women (86%) with a mean age of 75 years.
The independent variable was the type of out patient care, either CMD or GAU, to which the subjects were randomized. The dependent variables were recognition of UI by the health care providers and intervention or referral for the problem of UI once it was identified. Instruments included a structured in-home interview performed before randomization designed to uncover health problems such as urinary incontinence, as well as a medical record review form used post-assessment to ascertain recognition rates and intervention for UI by CMDS and GAUs. Both of the instruments were developed and piloted by the investigators in a preliminary study.
Of the 364 subjects, 151 (41.5%) reported UI during the in-home interviews. Recognition rates for UI were significantly better for GAUs (48 of 81, 59.3%) than CMDs (11 of 70, 15.7%) (P < 0.001). This was true for mild (< 3 times/week) 44.2% vs 2.1% (P < 0.000005) as well as severe UI (> 3 times/week) 86.2% vs 43.5% (P = 0.00111) for GAUs and CMDs, respectively. There were no significant differences in the rate of referral/intervention for recognized cases of UI by GAUs or CMDs. GAUs referred/treated five (21.7%) cases of mild UI and 10 (40%) cases of severe UI while CMDs referred/treated three (30%) cases of severe UI but did not offer intervention for the one recognized case of mild UI. GAUs were more likely to refer to Continence Programs (12, 25%) compared with CMDs who were more likely to refer (3, 100%) to a urologist. A majority of the subjects with UI did not receive treatment or referral for their problem (8, 72.7% CMDs and 33, 68.6% of GAUs).
GAUs out performed CMDs in the identification of subjects with both mild and severe UI. However, the intervention/referral rates were low for both GAUs and CMDs. The outcome of this study points to the need for increased emphasis on UI in curriculum preparing physicians and other health providers as well as the need for continuing education for those already in practice.
确定门诊老年评估单位（GAUs）和社区私人执业医生（CMDs）对尿失禁（UI）的识别率以及干预/转诊率的差异。
一项多中心、随机对照研究，采用区组随机化将65岁及以上的受试者分配至GAU或CMD进行评估。
一个学术性及三个医院附属的GAU，以及大城市地区的私人执业CMDs。
364名居家体弱男性（14%）和女性（86%），平均年龄75岁。
自变量为受试者随机分配至的门诊护理类型，即CMD或GAU。因变量为医疗保健提供者对UI的识别，以及识别出UI问题后的干预或转诊。工具包括随机分组前进行的结构化居家访谈，旨在发现诸如尿失禁等健康问题，以及评估后用于确定CMDs和GAUs对UI的识别率及干预情况的病历审查表。这两种工具均由研究者在初步研究中开发并进行了预试验。
在364名受试者中，151名（41.5%）在居家访谈中报告有UI。GAUs对UI的识别率（81名中的48名，59.3%）显著高于CMDs（70名中的11名，15.7%）（P<0.001）。对于轻度（每周<3次）UI，GAUs为44.2%，CMDs为2.1%（P<0.000005）；对于重度UI（每周>3次），GAUs为86.2%，CMDs为43.5%（P = 0.00111）。GAUs和CMDs对已识别的UI病例的转诊/干预率无显著差异。GAUs转诊/治疗了5例（21.7%）轻度UI病例和10例（40%）重度UI病例，而CMDs转诊/治疗了3例（30%）重度UI病例，但未对1例已识别的轻度UI病例进行干预。与CMDs相比，GAUs更有可能转诊至尿失禁项目（12例，25%），而CMDs更有可能转诊（3例，100%）至泌尿科医生。大多数有UI的受试者未因其问题接受治疗或转诊（CMDs为8例，72.7%；GAUs为33例，68.6%）。
在识别轻度和重度UI受试者方面，GAUs表现优于CMDs。然而，GAUs和CMDs的干预/转诊率均较低。本研究结果表明，在培养医生和其他医疗服务提供者的课程中需要更加强调UI，同时也需要对已从业的人员进行继续教育。
