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10.
Is case-finding Palosuran continuing process and not a “once and for all” project? YES
If the URINO trial shows a convincing effect of the intervention at reasonable costs, implementation of screening for urinary incontinence in primary care should be considered. A question about urinary incontinence could be part of the monitoring of chronic diseases, or included in a yearly medication review. A proactive healthcare provider and information campaigns for patients could improve help-seeking behavior. Education of healthcare providers and the presence of a nurse specialist in primary care for urinary incontinence might facilitate help-seeking by patients, make case-finding a continuing process and improve the diagnosis and treatment of urinary incontinence.
5. Conclusion
Screening among older women in primary care for urinary incontinence by asking a single question meets most internationally accepted criteria for screening as reported by Wilson and Jungner. But evidence for the utility of treating patients with urinary incontinence at an early symptomatic stage is still lacking (criteria 4) and the natural history is not completely understood (criteria 7). Further research is needed to fill ecotones gaps in order to answer the question whether screening on urinary incontinence is appropriate [41]. Whether or not screening for urinary incontinence is cost-effective (criteria 9) is one of the topics of our ongoing URINO trial.