Background: More than half of older adults experience urinary (UI) or fecal incontinence (FI), but the majority have never discussed symptoms with health care providers. Little is known about primary care providers’ (PCPs’) screening for UI and FI. Methods: We conducted a cross-sectional electronic survey of PCPs within a Midwest academic institution to ascertain and compare PCPs’ beliefs, attitudes, and behaviors regarding screening and treatment for UI and FI; determine factors associated with screening for FI; and identify potential barriers to and facilitators of FI screening and treatment. Results: Among 154 PCPs, the screening rate for UI (75%) was more than double that for FI (35%;P < .001). PCPs believed that both UI and FI screening were important but felt better informed to treat UI (P < .001). Screening for FI was associated with UI screening (OR, 11.27; 95% CI, 4.9–26.0; P < .001); feeling informed to treat FI (OR, 10.21; 95% CI, 1.2–90.0; P =.01); screening verbally (OR, 3.9; 95% CI, 1.9–8.0; P < .001); perceiving screening as important (OR, 3.7; 95% CI, 1.8–7.4; P < .001); using the term, “accidental bowel leakage” (OR, 2.9; 95% CI, 1.2–6.7; P =.02) or “bowel control issues” (OR, 2.2; 95% CI, 1.1–4.5; P =.03); and being a resident (OR, 0.37; 95% CI, 0.16–0.82; P = .02). PCPs reported high interest in patient and provider educational materials about UI and FI. Conclusions: Most PCPs screen for UI but not FI. High reported interest in educational materials, coupled with high reported rates of perceived importance of screening for UI and FI, suggests that PCPs welcome informative interventions to streamline diagnosis and treatment. (J Am Board Fam Med 2018; 31:774–782.)

amendment to our article and enthusiastically agree with the assertion that health equity is an important lens through which to gauge the effectiveness of payment models. While we assessed how these models affected health outcomes broadly, we agree that an important addition would be to specifically examine their impact on health equity.As Dr. Fiscella and Dr. Carroll note, risk-adjusted (based on social determinants of health in addition to medical determinants) global payments are one potential path toward equity, by ensuring that adequate resources are dedicated to patients with more complex needs and that there is flexibility in funds to meet social needs in addition to medical needs. In our characterization of payment models we have included whether the model includes risk adjustment.Another consideration relevant to payment models is to include measures of equity in performance metrics. We have raised concerns that models like the Merit-Based Incentive Payment System have the potential to widen existing disparities. 1 There is important work underway to develop measures that adequately assess primary care, including impact on health equity, begun at Starfield Summit III and being continued at the Larry A. Green Center for the Advancement of Primary Health Care for the Public Good.While primary care has been shown to attenuate health disparities, improved payment for primary care is necessary but not sufficient for achieving health equity. Achieving population health equity goals also requires ensuring access to health care for all, looking further upstream to payment for social services, and systematically addressing structural racism and discrimination.

INTRODUCTION: Obesity is the most common co-morbidity occurring in women across their lifespans, associated with reproductive health problems, gynecologic and breast cancers, and numerous chronic conditions. Maternal obesity is associated with pregnancy complications, infant mortality, and childhood obesity. The goals of this study were to assess obstetrics and gynecology (Ob-Gyn) providers' experiences, attitudes, and practices pertaining to obesity counseling and to identify target areas for further training. METHODS: A needs assessment survey was distributed to 85 Ob-Gyn providers at a mid-sized academic medical center. Participants included physicians, trainees, and advanced practice providers. RESULTS: One quarter (25.6%) of respondents had never been trained to communicate with patients about obesity while 43.6% had not received training beyond medical or professional school. Fewer than half (45.2%) said they were at least somewhat comfortable addressing the topic of obesity, and only 18% felt at least somewhat successful (0% felt very successful). Providers who were more comfortable talking about obesity were also more confident about their patients' success, as well as their own success in counseling patients. A majority of providers (52.1%) discuss obesity often or always with pregnant patients with obesity (PWOs), while only 27.0% discuss obesity often or always with non-pregnant PWOs. Comorbidities and severity of obesity were the two most influential factors in deciding whether to discuss obesity. Pregnancy status and upward trend in weight gain were also important factors. CONCLUSION: These findings were used to design department-wide educational and faculty development opportunities intended to improve provider comfort and efficacy in discussing obesity.