One automated question — “Do you have bothersome leakage of urine?” — helped increase awareness and referral for treatment of urinary incontinence in women in a large-scale assessment of an intervention in 43 primary care practices.

The study included 72,009 women (median age, 54 years) who received a urinary incontinence screening question electronically before or in person at their annual primary care visits. Those patients whose responses indicated bothersome urinary incontinence and interest in more information were offered an online education module about urinary incontinence and its treatments. Primary care clinicians received module results, an electronic health record alert, and an order set for treatment, including medications and physical therapy or subspecialty care referrals.

Findings of the research, led by Sarah A. Collins, MD, with the University of Chicago Pritzker School of Medicine in Chicago, were published online on February 9 in JAMA Internal Medicine.

Bothersome urinary incontinence symptoms and desire for more information were identified in 6578 women (9.1%). The average clinic-level rate of urinary incontinence diagnosis per 100 encounters was 4.2 at baseline. At the start of the urinary incontinence screening and the Identify, Teach, and Treat (IT2) intervention, researchers saw an immediate increase in urinary incontinence diagnoses by 0.51 per 100 encounters (95% CI, 0.12-0.91; P = .01), and the annual rate of diagnoses continued to increase an additional 0.55 per 100 encounters (95% CI, 0.05-1.05; P = .03).

Referrals Increased With Intervention

Referrals to pelvic floor physical therapy also saw an initial step increase of 0.38 per 100 encounters (95% CI, 0.23-0.53; P < .001) and an annual rate increase of 0.31 per 100 encounters (95% CI, 0.12-0.50; P = .001). At baseline, the rate of referral to subspecialty services was a mean of 0.5 per 100 encounters (0.2) and initially increased by a mean of 0.29 per 100 encounters (95% CI, 0.16-0.41; P < .001) after IT2 started but then remained constant.

Rate of Prescriptions Did Not Change

However, the rate of new prescriptions for urinary incontinence medication did not change after IT2 began. The authors wrote that there may be several reasons for this. It could be that the intervention improves clinician comfort with referrals but not with prescribing medications, or that the education module explains risks for some medications, which may have concerned clinicians. Additionally, it is possible that the women did not request medical management of their symptoms.

In an accompanying invited commentary, Marco H. Blanker, MD, PhD, with the Department of Primary and Long-term Care, Cure and Care in the Community Context research program, University Medical Center Groningen in Groningen, Netherlands, and colleagues, noted urinary incontinence’s “profound impact on patients’ lives” and endorsed the electronic screening intervention. They point out that urinary incontinence affects 1 in 3 women worldwide.

They added that because urinary incontinence typically is not the reason for a physician visit, it may go unnoticed. Patients with chronic cough, diabetes, or advanced age are at higher risk for urinary incontinence, but the symptoms may not be addressed amid the focus on other conditions, they wrote.

“By simply asking a single question, physicians can make a substantial difference,” they wrote.

Amy Cantor, MD, MPH, family physician and professor at Oregon Health & Science University in Portland, Oregon, who was not involved with the study, praised the researchers’ study “because it was a patient-centered approach that engaged the patient early in the process.”

However, the study did not assess the effectiveness of the screening intervention on outcomes, including symptoms, quality of life, and function, she noted. “They also did not compare their approach with another screening approach, so we do not know whether usual care or another screening tool or method resulted in similar outcomes.”

“The Women’s Preventive Services Initiative (WPSI) recommends screening women for urinary incontinence annually. Ideally, screening should assess whether women experience urinary incontinence and whether it affects their activities and quality of life before symptoms become severe,” she told Medscape Medical News.

An important next step is to measure clinical and patient-centered outcomes that result from increased screening. “More screening is not necessarily better unless the tool accurately identifies people with the condition and the proper resources are in place to facilitate appropriate referrals or treatments,” Cantor said.

Collins reported receiving personal fees from MCG Health and the American Board of Obstetrics and Gynecology Continuing Certification Development Committee, as well as receiving royalties from Elsevier for Comprehensive Gynecology, Ninth Edition, outside the submitted work. Co-authors’ disclosures are reported with the full paper. Blanker and a co-editorialist reported holding a patent for the URinControl app licensed to University Medical Center Groningen. The editorialists reported having no financial interests in the app but disclosed receiving funding for the development, testing, cost-effectiveness study, and nationwide implementation of this app in earlier and ongoing studies. Cantor reported having no relevant financial relationships.

Marcia Frellick is an independent, Chicago-based healthcare journalist and a regular contributor to Medscape Medical News.