Cover: Managing Urinary Incontinence for Women in Primary Care

Managing Urinary Incontinence for Women in Primary Care

Environmental Scan (Base Year)

Published Oct 20, 2022

by Sydne J. Newberry, Jeannette Tsuei, Jody Larkin, Aneesa Motala, Kayla Howard, Gena Dunivan

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Research Questions

  1. What implementation or dissemination strategies (including resources and tools) have been used to promote nonsurgical clinical interventions for identifying and treating UI, on their own or in combination, in adult women in primary care settings?
  2. What specific nonsurgical clinical interventions (pharmacologic and nonpharmacologic) were associated with each of the implementation or dissemination interventions?
  3. What were the contexts (primary care settings and patient populations) in which the implementation strategies and clinical interventions were introduced?
  4. What outcomes and evidence of effectiveness have been reported for the implementation or dissemination strategies? To what degree were the clinical interventions evidence-based?

Urinary incontinence (UI) is a highly prevalent condition among women worldwide. Although effective nonsurgical treatments exist, including pharmacological, behavioral, and physical therapies, many women with the condition are never diagnosed because of a lack of information, stigma, and the absence of regular screening in primary care, and those who are diagnosed might not receive or adhere to treatment.

In this report, the authors present an environmental scan of studies published from 2012 through 2022 that assess the dissemination and implementation of nonsurgical UI treatment — including screening, management, and referral strategies — for women in primary care. The scan was conducted as part of the RAND's support and evaluation contract for the Agency for Healthcare Research and Quality's Managing Urinary Incontinence initiative. The initiative, which builds on the agency's EvidenceNOW model, funds five grant projects to disseminate and implement improved nonsurgical treatment of UI for women within primary care practices in separate regions of the United States.

Key Findings

  • The environmental scan identified only 14 studies that met the literature search inclusion criteria.
  • Most of the studies focused on implementation of a specific care intervention (e.g., screening tool, digital app, nurse practitioner management of UI care) without use of broader implementation and dissemination strategies (e.g., practice coaches, learning collaboratives).
  • Most studies addressed multiple levels of the primary care system, such as interventions for patients and primary care providers.
  • Improving screening is a critical first step to better treatment of UI for women in primary care. But additional focus on dissemination and implementation strategies to improve UI diagnosis, management, and referral is also needed.

Research conducted by

The research described in this report was prepared for the Agency for Healthcare Research and Quality (AHRQ) and conducted by RAND Health Care.

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