ECHO-Chicago: Urinary Incontinence in Primary Care

Urinary incontinence (UI) affects over 50% of women. Its prevalence increases with age rendering up to 75% of women over age 65 with some degree of UI. Approximately 50% of women with UI experience daily symptoms, and an additional 30% have symptoms at least weekly. UI adversely affects the physical, psychological, and social well-being of millions. Non-surgical treatment, including behavioral interventions or pharmacotherapy, is usually effective, but recognition in health care settings and evidence-based care for this condition remains suboptimal. In fact, only half of the estimated 40% of Medicare beneficiaries with UI who have spoken to a physician receive treatment. Treatment in primary care, with system support and availability of specialty care, has great potential. Unfortunately, a variety of patient, provider, and system-level barriers result in under-diagnosis and suboptimal management. ECHO-Chicago in partnership with UI specialists and primary care physicians from University Hospitals Cleveland Medical Center Urology Institute has put together this series to increase the workforce capacity of nurse navigators and primary care physicians who are working with medically complex individuals with urinary incontinence. Funding from AHRQ will support planning and implementation of the UI series. The series is comprised of eight one hour-long sessions that will be facilitated by a team of subject matter experts. Sessions will consist of short didactic presentations (~20-30 minutes), followed by participant-led case presentations (new and follow-up cases). This structure, modeled after medical rounds, allows participants to apply the knowledge gained and openly discuss the real-world challenges of implementing recommended best practices. Through these discussions, the series facilitators and participants draw on their own experience to support each other and share strategies that they have found to be successful in navigating barriers. The goal of this activity is to increase the workforce capacity of nurse navigators and primary care physicians working with medically complex individuals with urinary incontinence.

At the conclusion of this activity, participants will be able to:

• Define urinary incontinence (UI), its causes, types and prevalence;
• Describe the basic office evaluation of UI;
• Discuss how to manage UI using behavioral therapy like bladder diary and bladder training;
• Define third-line overactive bladder (OAB) treatment, its indications and contraindications, and treatment options;
• State how physical therapy can be used to manage UI;
• Identify advanced management techniques for OAB, including onabotulinumtoxinA, percutaneous tibial nerve stimulation, and neural stimulation therapy;
• Name surgical management techniques for stress UI, including bulking and slings;
• Recognize a complex patient that is a good candidate for early referral.