Quality-of-care gaps persist in the management of women with urinary incontinence in primary care practices

Although primary care physicians provide the first line of defense against urinary incontinence (UI), this condition, which affects quality of life for many women, is not adequately managed in primary care, according to findings from a multicenter study conducted in Kansas and Southern California.

The Women's Preventive Services Initiative recommends annual screening for several conditions with a significant prevalence among women, including urinary incontinence. Despite these recommendations and the availability of effective nonsurgical therapies for UI, gaps in the quality of care for this condition persist at the primary care level. In an attempt to address these gaps, providers from three health institutions in Kansas and Southern California participated in a quality improvement initiative targeting interventions for UI in primary care. As part of the larger initiative, a study was designed to evaluate the baseline performance of primary care providers regarding key UI quality-of-care indicators (QI), with the aim of identifying critical areas for improvement in the delivery of care.

A retrospective chart review of four to six charts per provider was conducted to assess primary care performance in relation to 11 evidence-based QI. Charts of patients evaluated or treated within 2 years before study initiation were identified using ICD-9/10 codes for UI. The final analysis included a total of 140 patient charts generated by 42 primary care providers at two of the health institutions, namely University of California San Diego Health and the University of Kansas Medical Center. A review of diagnostic approaches revealed that routine pelvic exams and urinalysis were underutilized: 30 (24%) patients had pelvic exams performed within the past year and 37 (29%) patients had undergone urinalysis within 3 months of their visit. Most charts (83%) detailed the type of UI (stress, urge, or mixed), however, only a small portion documented key aspects of UI management such as history of previous treatments (16%) and fluid intake (9%). In terms of management, 31 (42%) patients were prescribed pelvic floor exercises or referred for pelvic floor physical therapy, 24 (26%) were advised on behavioral modifications, including fluid restriction, and 16 (26%) patients with a body mass index > 25 were advised to lose weight. Overall, patients had an average score of 39% (SD+/-26) of the recommended level of care, suggesting a low adherence to evidence-based interventions for UI among primary care providers.

The authors noted that the low rates of use of lifestyle interventions with established effectiveness for UI, such as pelvic floor exercises, behavioral modifications, and weight loss interventions, signal a missed opportunity for first-line, noninvasive treatment of a condition that affects physical and mental wellbeing in a significant portion of women. 
“These preliminary data are part of a larger urinary incontinence study funded by the Patient-Centered Outcomes Research Institute to test the use of electronic consults versus advance practice provider co-management,” said lead author Anthony Galvez, a fourth-year student at the University of California San Diego School of Medicine, who presented the findings at the 2025 Annual Meeting of the American Urological Association in Las Vegas, Nevada.

The ongoing quality improvement project includes provider education, electronic decision support, and structured referral mechanisms, which have the potential to improve care delivery for UI as well as patient outcomes. “Providers [involved in the study] also receive a UI lecture and clinical decision support tools,” Galvez added. “These quality indicators and recommended management are discussed [during the lecture]. We hope that by bringing attention to this issue, providing education, as well as screening patients for UI prior to their appointments, we will help address these gaps. Provider performance on these quality indicators will be reassessed after 6 months in the study, and we expect to see an improvement in scores.”