General practitioners’ management of female urinary incontinence: Medical records do not reflect patients’ recall

Abstract

Objectives - To investigate the prevailing management of female urinary incontinence by Norwegian general practitioners (GPs), and to compare information given by the patients with information in their medical records.

Design - Incontinent women who had received reimbursement for incontinence aids or drugs were identified by the local Insurance Offices, and a random sample was interviewed about what examinations and treatments they had received. Similar information was later collected from their GPs.

Setting - the Bergen area, Norway.

Subjects - Forty-eight GPs and 82 patients.

Main outcome measures - Actions taken according to the patients and their medical records. Kappa statistics were used to evaluate the strength of agreement.

Results - the GPs had done a gynaecological examination in 54%, a leakage provocation test in 12%, and a urinalysis in 73% of the patients. Thirty-two per cent of the women had been instructed in pelvic floor exercises and 13% in bladder training. the GPs had prescribed oestrogens for 48% of the older women (>59 years), anticholinergics for 29% of those with urge or mixed incontinence. Overall Kappa between the two data sources was 0.37.

Conclusion - GPs’ incontinence management can be improved, especially regarding gynaecological examination, pelvic floor exercises, and the prescription of oestrogens. Retrospective chart data or patient interviews are unreliable data sources.

Key Words:

• urinary incontinence
• female
• family practice
• quality of health care
• medical records