Evaluating Didactic Education and Patient Characteristics in Urinary Incontinence Screening

Objectives: Urinary incontinence, a prevalent condition among women, can significantly impair their quality of life. Unfortunately, many women are hesitant to seek medical attention for this, resulting in preventable diminished functional status and social integration. Therefore, annual screening for incontinence is recommended, but not consistently done in primary care nor OB/GYN outpatient settings. OB/GYN trainees should regularly screen for incontinence during outpatient annual visits. This project aims to evaluate if didactic education for residents increases screening rates and identify demographic factors that may lead to screening and work-up of incontinence.

Methods: This study conducted a retrospective chart review of 139 patients who visited an academic OB/GYN outpatient office for an annual gynecological visit between January 2022 and May 2022. Screening for incontinence was evaluated by analyzing the documentation of the presence or absence of symptoms. Demographic data was collected on analyzed patients. Education for residents was provided during an hour-long didactic session. The study obtained institutional review board approval to ensure ethical compliance.

Results: The study found that 37% (n=52/139) of patients were screened for incontinence overall. Prior to didactic education, the screening rate was 35.5%, while after the education, it increased to 39.7%. The average age of screened patients was 44.9, which was similar to the average age of an annual visit at 42.9 (p=0.11). There was no significant difference in BMI between those who were screened and those who were not (28.9 versus 26.9, p=0.056). No difference existed between the groups for the total number of pregnancies (p=0.09), regardless of mode of delivery. Racial status did not significantly affect rates of screening between Caucasian (28%, p=0.36) and Hispanic (46%, p=0.21) patients. There was no statistical difference between screening rates for patients with private (52%) versus public insurance (52% vs 38.5%, p=0.75). Among those screened, only 51.9% had documented presence of symptoms of incontinence, urgency, or frequency, and 37% underwent work-up with urinalysis or urine culture. Only 14% were referred to a urogynecologist or urologist.

Conclusions: Because urinary incontinence can be a difficult subject for patients to discuss, eliciting information and screening for symptoms is a key role of a physician and should occur routinely. At this academic practice, overall rates of screening for incontinence remain unacceptably low, at only 37%. Unfortunately, a dedicated didactic session did not significantly impact the rate of incontinence screening. There does not appear to be any bias for screening when evaluating BMI, race, parity or insurance status. Further interventions must be developed to address barriers and enhance routine screening for incontinence.