Nancy O'Reilly, MHS; Heidi D. Nelson, MD, MPH; Jeanne M. Conry, MD, PhD; Jennifer Frost, MD; Kimberly D. Gregory, MD, MPH; Susan M. Kendig, JD, WHNP-BC; Maureen Phipps, MD, MPH; Alina Salganicoff, PhD; Diana Ramos, MD, MPH; Christopher Zahn, MD; Amir Qaseem, MD, PhD, MHA; for the Women's Preventive Services Initiative *
Disclaimer: Advisory panel or Multidisciplinary Steering Committee participation in the WPSI or authorship of this document does not constitute organizational or individual endorsement of the recommendations or conclusions. The findings and conclusions in this document do not necessarily represent the views of HRSA. No statement in this report should be construed as an official position of the U.S. Department of Health and Human Services.
Grant Support: This project is supported by the HRSA of the U.S. Department of Health and Human Services under a cooperative agreement (UH0MC29440).
Disclosures: Ms. O'Reilly reports grants from HRSA during the conduct of the study. Dr. Gregory reports grants from the Patient-Centered Outcomes Research Institute and California Health and Human Services Agency outside the submitted work. Dr. Phipps reports travel reimbursement for volunteer work being done for ACOG. Authors not named here have disclosed no conflicts of interest. All financial and intellectual disclosures of interest were declared and potential conflicts were discussed and managed following the conflict of interest process of ACOG. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0595.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Corresponding Author: Amir Qaseem, MD, PhD, MHA, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, firstname.lastname@example.org.
Current Author Addresses: Ms. O'Reilly and Dr. Zahn: American College of Obstetricians and Gynecologists; 409 12th Street Southwest, Washington, DC 20024.
Dr. Nelson: Oregon Health & Science University, mail code: BICC, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239.
Dr. Conry: 8204 Canteshire Way, Granite Bay, CA 95746.
Dr. Frost: American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211.
Dr. Gregory: Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 160W, Los Angeles, CA 90048.
Ms. Kendig: National Association of Nurse Practitioners in Women's Health; 505 C Street Northeast, Washington, DC 20002.
Dr. Phipps: Women and Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905.
Dr. Salganicoff: Kaiser Family Foundation, 2400 Sand Hill Road, Menlo Park, CA 94025.
Dr. Ramos: California Department of Public Health, P.O. Box 997377, Sacramento, CA 95899.
Dr. Qaseem: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Author Contributions: Conception and design: N. O'Reilly, H.D. Nelson, J.M. Conry, K.D. Gregory, S.M. Kendig, M. Phipps, C. Zahn, A. Qaseem.
Analysis and interpretation of the data: N. O'Reilly, H.D. Nelson, S.M. Kendig, M. Phipps, A. Salganicoff, C. Zahn, A. Qaseem.
Drafting of the article: N. O'Reilly, H.D. Nelson, M. Phipps, A. Qaseem.
Critical revision for important intellectual content: N. O'Reilly, H.D. Nelson, J.M. Conry, J. Frost, K.D. Gregory, S.M. Kendig, M. Phipps, D. Ramos, C. Zahn, A. Qaseem.
Final approval of the article: N. O'Reilly, H.D. Nelson, J.M. Conry, J. Frost, K.D. Gregory, S.M. Kendig, M. Phipps, A. Salganicoff, D. Ramos, C. Zahn, A. Qaseem.
Provision of study materials or patients: H.D. Nelson.
Statistical expertise: H.D. Nelson, A. Qaseem.
Obtaining of funding: N. O'Reilly, H.D. Nelson, J.M. Conry, C. Zahn.
Administrative, technical, or logistic support: N. O'Reilly, H.D. Nelson, C. Zahn, A. Qaseem.
Collection and assembly of data: H.D. Nelson.
Recommendation on screening for urinary incontinence in women by the Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient representatives. The WPSI's recommendations are intended to guide clinical practice and coverage of services for the Health Resources and Services Administration and other stakeholders. The target audience for this recommendation includes all clinicians providing preventive health care for women, particularly in primary care settings. This recommendation applies to women of all ages, as well as adolescents.
The WPSI developed this recommendation after evaluating evidence regarding the benefits and harms of screening for urinary incontinence in women. The evaluation included a systematic review of the accuracy of screening instruments and the benefits and harms of treatments. Indirect evidence was used to link screening and health outcomes in the chain of evidence that might support screening in the absence of direct evidence. The WPSI also considered the effect of screening on symptom progression and avoidance of costly and complex treatments, as well as implementation factors.
The WPSI recommends screening women for urinary incontinence annually. Screening ideally should assess whether women experience urinary incontinence and whether it affects their activities and quality of life. The WPSI recommends referring women for further evaluation and treatment if indicated.
Organizational structure of the WPSI.
AAFP = American Academy of Family Physicians; ACOG = American College of Obstetricians and Gynecologists; ACP = American College of Physicians; EPC = Evidence-based Practice Center; HRSA = Health Resources and Services Administration; IOM = Institute of Medicine; NPWH = National Association of Nurse Practitioners in Women's Health; WPSI = Women's Preventive Services Initiative.
Table 1. Screening Instruments for Urinary Incontinence*
Table 2. Strength of Evidence
Table 3. The American College of Physicians' Guideline Grading System*
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O'Reilly N, Nelson HD, Conry JM, Frost J, Gregory KD, Kendig SM, et al. Screening for Urinary Incontinence in Women: A Recommendation From the Women's Preventive Services Initiative. Ann Intern Med. ;169:320–328. doi: 10.7326/M18-0595
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Published: Ann Intern Med. 2018;169(5):320-328.
Published at www.annals.org on 14 August 2018
Guidelines, Nephrology, Urological Disorders.
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