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

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.