IDENTIFICATION AND INTERVENTION FOR URINARY-INCONTINENCE BY COMMUNITYPHYSICIANS AND GERIATRIC ASSESSMENT TEAMS

Objective: To determine the difference in the recognition and interven tion/referral rates for urinary incontinence (UI) by out-patient Geria tric Assessment Units (GAUs) and private physicians in community-based practices (CMDs). Design: 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. Setting: One ac ademic and three hospital-based GAUs and CMDs in private practice in a large metropolitan area. Participants: Three hundred sixty-four commu nity-dwelling frail men (14%) and women (86%) with a mean age of 75 ye ars. Measurements: The independent variable was the type of out patien t care, either CMD or GAU, to which the subjects were randomized. The dependent variables were recognition of UI by the health care provider s and intervention or referral for the problem of UI once it was ident ified. Instruments included a structured in-home interview performed b efore randomization designed to uncover health problems such as urinar y incontinence, as well as a medical record review form used post-asse ssment to ascertain recognition rates and intervention for UI by CMDS and GAUs. Both of the instruments were developed and piloted by the in vestigators in a preliminary study. Main Results: Of the 364 subjects, 151 (41.5%) reported UI during the in-home interviews. Recognition ra tes for UI were significantly better for GAUs (48 of 81, 59.3%) than C MDs (11 of 70, 15.7%) (P < 0.001). This was true for mild (<3 times/we ek) 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 we re no significant differences in the rate of referral/intervention for recognized cases of UI by GAUs or CMDs. GAUs referred/treated five (2 1.7%) cases of mild UI and 10 (40%) cases of severe UI while CMDs refe rred/treated three (30%) cases of severe UI but did not offer interven tion for the one recognized case of mild UI. GAUs were more likely to refer to Continence Programs (12, 25%) compared with CMDs who were mor e 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, 7 2.7% CMDs and 33, 68.6% of GAUs). Conclusions: GAUs out performed CMDs in the identification of subjects with both mild and severe UI. Howev er, the intervention/referral rates were low for both GAUs and CMDs. T he outcome of this study points to the need for increased emphasis on UI in curriculum preparing physicians and other health providers as we ll as the need for continuing education for those already in practice.