63: Using the questionnaire for urinary incontinence diagnosis as screening tool in low resource settings

Abstract

The Questionnaire for Urinary Incontinence Diagnosis (QUID) is a validated and reliable 6-item urinary incontinence (UI) symptom questionnaire used to distinguish patients with urge (UUI), stress (SUI) and mixed incontinence (MUI). We aim to evaluate the utility of QUID as a tool for untrained community health workers (CHW) in low resource settings. We aim to determine whether the QUID can help identify patients with UI who will benefit from physician evaluation. A Spanish version of the QUID has been validated in Spanish-speaking populations in Latin America and the United States of America using the TRAPD (translation, review, adjudication, pre-testing, and documentation) method. We collaborated with Saving Mothers and the Institute for Latin American Concern Mission Center in Santiago, Dominican Republic, which outreaches to 160 rural communities with limited access to care. At an annual educational symposium, the CHWs or “cooperadoras” were taught to administer the QUID to women complaining of UI. These women were then referred to the main clinical evaluation center for a UI assessment. A clinician asked these women 3 stress-related and 5 urge-related questions. The diagnosis after administration of the QUID by the CHWs was correlated with physician diagnosis after asking these 8 clinician questions. Clinicians then performed a thorough physical examination, urine dipstick, post-void residual, cough stress test, and simple cystometrics on patients with a negative cough stress test. The QUID diagnosis was correlated to physician diagnosis after both clinician questions and physical examination. The CHWs administered the QUID to 101 women who had complaints of UI with following diagnoses: MUI 73.2%, UUI 6%, SUI 0%, and no incontinence 20.8%. After initial clinician evaluation and the 8 clinician questions, diagnoses were as follows: MUI 34.65%, UUI 4%, SUI 34.65%, and 26.7% with no incontinence. The correlation coefficient between the QUID and the clinician questions was 0.78. After thorough physical examination as above, final diagnoses were as follows: MUI 15.8%, UUI 14.9%, SUI 26.7%, 41.6% with no incontinence, and 1% with a urinary tract infection. The correlation coefficient between the QUID and the final diagnosis was 0.185 (Table 1). CHW diagnosis after QUID administration correlated well with clinician diagnosis after 8 clinician questions. This suggests that the QUID can be an excellent screening tool for CHWs in rural communities for triage, just as the 8 clinician questions are used to triage patients by physicians prior to physical examination and evaluation. It should be noted that the QUID does not diagnose SUI as frequently as physicians do with clinician questions on initial evaluation. The QUID diagnosis poorly correlated with physician final diagnosis. This is likely because additional tests, such as urine dipstick, post-void residual, cough stress test, and simple cystometrics supply more information to differentiate accurately between SUI and UUI, which were diagnosed much more frequently from the physician diagnosis than the QUID diagnosis. However, the QUID was able to identify high-risk women who should receive an evaluation by a physician for UI.