EHR Alerts and Urinary Incontinence Counseling Among Primary Care Providers

Friday, October 25, 2024

2:45 PM – 2:49 PM EDT

Location: Independence Ballroom E-H (Meeting Level 4)

Objectives: Women, despite being bothered by urinary incontinence (UI), often do not mention it to their primary care provider (PCP). In addition, PCPs, who are often burdened by numerous conditions to address, do not always ask about UI. We sought to compare the efficacy of electronic notification strategies in influencing a UI discussion between provider and patient.

Methods: Primary care providers (PCPs) from three Southern California health institutions were invited to participate in a multi-pronged UI educational intervention between July 2019 and October 2023. Patients were recruited to the study using an email or telephone-based survey that screened for bothersome UI prior to their primary care appointment. At one health institution, PCPs were notified of a positive screen through an interruptive clinical decision support (CDS) alert in the electronic health record (EHR) on the day of the appointment. At another institution without this interruptive capability, PCPs were notified of a positive screen through a non-interruptive reminder on their clinic schedule template (a “sticky note”). At the third site, providers were alerted by both email and an EHR message (but no alert). Patients were also advised to discuss incontinence with their providers at the time of recruitment. After the appointment, the progress note was reviewed for documentation of a discussion about UI.

Results: A total of 80 primary care physicians were recruited between the two sites. In this time frame, 209 patients were recruited to participate 1-2 weeks prior to their PCP visit. At the institution where an interruptive BPA was used, 39/57 (68.4%) had a documented discussion of UI after their PCP visit compared with 32/60 (53.3%) of patients at the institution where a non-interruptive reminder was used. This compared to 19/92 (21.1%) in which providers were contacted by message and email.

Conclusions: In our sample, the use of reminders in the electronic health record was feasible and effective. Though an interruptive alert performed better, a non-interruptive EHR reminder yielded discussion of urinary incontinence in the majority of clinical encounters and was much more effective than messaging without alerts. Given that patients rarely discuss UI with their PCPs, even when bothered, the use of best practice advisories may increase likelihood of discussion, treatment, and referral for UI concerns.

Disclosure(s):

Samantha DeAndrade, MD, MPH: No financial relationships to disclose

K. Marie Douglass, MD/MPH: No financial relationships to disclose

Kyle Okamuro, BS: No financial relationships to disclose

Jejo Koola: No financial relationships to disclose

Jennifer Singer, MD: No financial relationships to disclose

Joshua Pevnick, MD MSHS: No relevant disclosure to display

Ramy Eskander, MD: No financial relationships to disclose

Jennifer Anger, MD, MPH: No relevant disclosure to display

Tajnoos Yazdany, MD: No financial relationships to disclose

Presenting Author(s)

Samantha DeAndrade, MD, MPH (she/her/hers)

Physician
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States

Disclosure(s): No financial relationships to disclose

Co-Author(s)

K. Marie Douglass, MD/MPH (she/her/hers)

Fellow
Harbor-UCLA Medical Center
Los Angeles, California, United States

Disclosure(s): No financial relationships to disclose
KO

Kyle Okamuro, BS

Research Project Manger
UC San Diego
San Diego, California, United States

Disclosure(s): No financial relationships to disclose
JK

Jejo Koola

Associate Professor
University of California San Diego
La Jolla, California, United States

Disclosure(s): No financial relationships to disclose
JS

Jennifer Singer, MD

Professor of Urology
UCLA
Santa Monica, California, United States

Disclosure(s): No financial relationships to disclose
JP

Joshua Pevnick, MD MSHS

Associate Professor
Cedars-Sinai Medical Center
Los Angeles, California, United States

Disclosure(s): No relevant disclosure to display
RE

Ramy Eskander, MD (he/him/his)

Assoc Professor, Chief Medical Information Officer
Harbor-UCLA Medical Center
Torrance, California, United States

Disclosure(s): No financial relationships to disclose
JA

Jennifer Anger, MD, MPH (she/her/hers)

Professor and Vice Chair of Research
UCSD Department of Urology
San Diego, California, United States

Disclosure(s): No relevant disclosure to display
TY

Tajnoos Yazdany, MD (she/her/hers)

Vice Chair of Education, Program Director
Harbor UCLA medical center
Playa vista, California, United States

Disclosure(s): No financial relationships to disclose