The Quality of Care Provided to Vulnerable Older Community-Based Patients with Urinary Incontinence

Published in: Journal of the American Medical Directors Association, v. 5, no. 3, May-June 2004, p. 141-146

Posted on RAND.org on January 01, 2004

by N. Gnanadesigan, Debra Saliba, Carol P. Roth, David Solomon, John T. Chang, John Schnelle, Rick L. Smith, Paul G. Shekelle, Neil S. Wenger

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OBJECTIVE: The objective of this study was to assess the quality of care provided to vulnerable older community-based patients with urinary incontinence (UI). DESIGN: The authors conducted an observational study using medical record review and patient (or proxy) interview. PARTICIPANTS: They studied 372 randomly selected community-dwelling older patients enrolled in two senior managed care plans identified by interview to be at increased risk for functional decline or death. MEASUREMENTS: Percentage of quality indicators passed for patients with UI. RESULTS: Thirty-six percent of the patients reported having UI, and during a 13-month period, 32 (7%) presented to their physician with new or worsening UI. Analysis of medical records for these 32 patients revealed that characteristics of voiding were documented for 75% of the patients with new or worsening UI, but importance of the problem, toileting function, and prior treatment were rarely addressed. Pelvic examination was performed for 20% of female patients and a rectal examination for 42% of men. Only 38% had a urinalysis performed and 16% had a postvoid residual. Drug treatment was prescribed for 50% of the patients but behavioral intervention for only 13%. Compared with patients seen by primary care providers alone, patients seen in consultative care received more comprehensive evaluation and treatment of UI. CONCLUSION: Quality of care for UI provided to vulnerable older patients, particularly by primary care providers alone, is inadequate. Despite the proven effectiveness of patient-dependent behavioral treatments, physicians rarely prescribe these interventions for UI.

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