目的:描述初级保健提供者(PCP)评估和管理女性尿失禁(UI)的做法,并根据高质量临床指南中的建议评估这些实践。
方法:在四个数据库中搜索了研究(MEDLINE,EMBASE,CINAHL,WebofScience)从各自的成立日期到2023年3月6日。所有描述女性患者PCP使用的UI评估和管理实践的研究均符合资格。两名评审员独立选择的研究评估了其质量并提取了数据。对纳入的研究进行了叙述性综合,以描述实践。然后将相关的评估和管理实践与当前高质量用户界面指南中一致的建议进行比较。药物治疗,转介,和随访报告仅描述性。
结果:共检索到3475篇文章,其中,审查中包括31名。大多数人报告对进行骨盆检查的依从性差-中度(报告的依从性范围:23-76%;基于8项研究),腹部检查(0-87%;三项研究),盆底肌肉评估(9-36%;两项研究),和膀胱日记(0-92%;9项研究),而尿液分析的依从性高(40-97%;9项研究)。对于UI的保守管理,研究表明,对盆底肌肉训练建议的依从性差-中度(5-82%;9项研究),膀胱训练(2-53%;8项研究)和生活方式干预(1-71%;6项研究)。关于药物治疗,PCP主要处方抗毒蕈药(2-46%;9项研究)和雌激素(2-77%;7项研究)。最后,PCP将那些报告UI的人转介给医学专家(5-37%;14项研究)。通常在诊断后<30天进行转诊,泌尿科医师是评估和治疗UI的最专业人员。
结论:本综述显示,对临床实践指南建议的依从性较差。虽然这些发现反映了报告的高度可变性,关键信息是,PCP提供的女性UI患者护理的大多数方面都需要改善。
OBJECTIVE: To describe primary care provider (PCP) practices for the assessment and management of females with urinary incontinence (UI), and appraise these practices relative to recommendations made in high-quality clinical guidelines.
METHODS: Studies were searched in four databases (MEDLINE, EMBASE, CINAHL, Web of Science) from their respective inception dates to 6 March 2023. All studies describing UI evaluation and management practices used by PCPs for female patients were eligible. Two reviewers independently selected studies assessed their quality and extracted data. A narrative synthesis of included studies was performed to describe practices. Relevant evaluation and management practices were then compared to recommendations that were consistent across current high-quality UI guidelines. Pharmacotherapy, referrals, and follow-ups were reported descriptively only.
RESULTS: A total of 3475 articles were retrieved and, among those, 31 were included in the review. The majority reported a poor-moderate adherence to performing a pelvic examination (reported adherence range: 23-76%; based on eight studies), abdominal examination (0-87%; three studies), pelvic floor muscle assessment (9-36%; two studies), and bladder diary (0-92%; nine studies), while there was high adherence to urine analysis (40-97%; nine studies). For the conservative management of UI, studies revealed a poor-moderate adherence to recommendations for pelvic floor muscle training (5-82%; nine studies), bladder training (2-53%; eight studies) and lifestyle interventions (1-71%; six studies). Regarding pharmacotherapy, PCPs predominantly prescribed antimuscarinics (2-46%; nine studies) and oestrogen (2-77%; seven studies). Lastly, PCPs referred those reporting UI to medical specialists (5-37%; 14 studies). Referrals were generally made <30 days after diagnosis with urologists being the most sought out professional to assess and treat UI.
CONCLUSIONS: This review revealed poor-moderate adherence to clinical practice guideline recommendations. While these findings reflect high variability in reporting, the key message is that most aspects of patient care for female UI provided by PCPs needs to improve.