| アブストラクト | BACKGROUND: Female urinary incontinence is underdiagnosed and undertreated in primary care. There is little evidence on factors that determine whether women with urinary incontinence are referred to specialist services. This study aimed to investigate characteristics associated with referrals from primary to specialist secondary care for urinary incontinence. METHODS: We carried out a cohort study, using primary care data from over 600 general practices contributing to the Clinical Practice Research Datalink (CPRD) in the United Kingdom. We used multi-level logistic regression to estimate adjusted odds ratios (aOR) that reflect the impact of patient and GP practice-level characteristics on referrals to specialist services in secondary care within 30 days of a urinary incontinence diagnosis. All women aged >/=18 years newly diagnosed with urinary incontinence between 1 April 2004 and 31 March 2013 were included. One-year referral was estimated with death as competing event. RESULTS: Of the 104,466 included women (median age: 58 years), 28,476 (27.3%) were referred within 30 days. Referral rates decreased with age (aOR 0.34, 95% CI 0.31-0.37, comparing women aged >/=80 with those aged 40-49 years) and was lower among women who were severely obese (aOR 0.84, 95% CI 0.78-0.90), smokers (aOR 0.94, 95% CI 0.90-0.98), women from a minority-ethnic backgrounds (aOR 0.76, 95% CI 0.65-0.89 comparing Asian with white women), women with pelvic organ prolapse (aOR 0.77, 95% CI 0.68-0.87), and women in Scotland (aOR 0.60, 95% CI 0.46-0.78, comparing women in Scotland and England). One-year referral rate was 34.0% and the pattern of associations with patient characteristics was almost the same as for 30-day referrals. CONCLUSIONS: About one in four women with urinary incontinence were referred to specialist secondary care services within one month after a UI diagnosis and one in three within one year. Referral rates decreased with age which confirms concerns that older women with UI are less likely to receive care according to existing clinical guidelines. Referral rates were also lower in women from minority-ethnic backgrounds. These finding may reflect clinicians' beliefs about the appropriateness of referral, differences in women's preferences for treatment, or other factors leading to inequities in referral for urinary incontinence. |
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| ジャーナル名 | BMC family practice |
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| Pubmed追加日 | 2020/10/18 |
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| 投稿者 | Gurol-Urganci, Ipek; Geary, Rebecca S; Mamza, Jil B; Iwagami, Masao; El-Hamamsy, Dina; Duckett, Jonathan; Wilson, Andrew; Tincello, Douglas; van der Meulen, Jan |
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| 組織名 | Department of Health Services Research and Policy, London School of Hygiene and;Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.;Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians;and Gynaecologists, London, UK.;Department of Health Services Research, University of Tsukuba, Tsukuba, Japan.;Department of Non-Communicable Disease Epidemiology, London School of Hygiene and;Tropical Medicine, London, UK.;Leicester General Hospital, Women's and Children's Clinical Business Unit,;University Hospitals of Leicester NHS Trust, Leicester, UK.;Medway NHS Foundation Trust, Gillingham, Kent, UK.;Department of Health Sciences, College of Life Sciences, University of Leicester,;Leicester, UK.;jan.vandermeulen@lshtm.ac.uk.;and Gynaecologists, London, UK. jan.vandermeulen@lshtm.ac.uk. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/33066730/ |
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