Evaluating the early effects of using an online educational module to elicit patient preferences for treatment following pre-visit screening for urinary incontinence in primary care.

Abstract

Urinary incontinence (UI) is common but patients are often unaware of treatment options. To determine whether UI treatment preferences elicited by an online module are congruent with primary care provider (PCP) action. Retrospective cohort study of female patients from 21 clinics over 10 months who were screened electronically for bothersome UI before preventive PCP visits. Positive screens were offered an interactive module. The results, including treatment preferences, were delivered to the PCP. We described participants who moved through the intervention and compared patient preferences with PCP action, defining congruence as any action aligned with the module results. Of 1074 patients reporting bothersome UI, 128 (11.9%) completed the entire module. The PCP opened the result before the day of visit in 55% of cases and documented UI in the visit note 29 times (56%). Of 128 module completers, 16 received physical therapy referrals, 4 educational handouts, none were prescribed medications. A total of 66 patients desired procedural treatment, which requires a subspecialty referral. A total of 31 subspecialty referrals were placed; 7 for patients who were not interested in advanced treatment. Congruence was seen in 49/128 (38%) encounters and did not differ whether the PCP had reviewed the module results or not (P = 1.0). Completion rates of a UI educational module in primary care are low, and results were not consistently reviewed by PCPs. Congruence between module results and PCP action is low. These findings do not support continuation of our current implementation and simpler strategies to facilitate patient education and shared decision-making should be explored.